Clinical Research On Risk Factors And Treatment Strategies For Hemorrhagic Transformation Of Massive Cerebral Infarction

Objective:Hemorrhagic transformation?HT?is a complication that may lead to deterioration of neurological function in patients with acute ischemic stroke.Hemorrhagic transformation may occur within the first week after symptom onset in 20%to 40%of patients with acute cerebral infarction?The incidence of hemorrhagic transformation is higher in patients with acute massive cerebral infarction,which endangers the life of patients.At present,there are many clinical studies about the risk factor for massive cerebral infarction,such as hrombolytic treatment,atrial fibrillation and cardiogenic cerebral embolism.However,there are relatively few studies on the influencing factors and clinical treatment strategies of HT in massive cerebral infarction without thrombolytic therapy and non-cardiac embolism.The aim of this study:1.To observe the risk factors associated with HT after non-thrombolysis in acute massive cerebral infarction,and to provide new ideas for clinical prediction of HT after non-thrombolysis in massive cerebral infarction;2.How to apply anti-platelet aggregation drugs to achieve a good prognosis after HT after massive cerebral infarction without thrombolysis and provide evidence for the safe and effective treatment of HT after massive cerebral infarction without thrombolysis.Methods:A total of 200 cases of non-thrombolytic patients with acute massive cerebral infarction admitted to the department of neurology of the second hospital of hebei medical university from January 2015 to December 2018were selected.100 cases of patients with hemorrhagic transformation?HT group?were selected as the experimental group,while those without hemorrhagic transformation?non-HT group?were selected as the control group.The data were collected about the general information?age and gender?,previous history?hypertension,stroke,diabetes?,clinical data?clinical symptoms,time of occurrence,Infarction nature,clinical efficacy and prognosis?,laboratory indicators(Ca²⁺,platelet count,TG,TC,HDL-C,LDL-C);imaging examination data?infarct diameter and size?;neurological deficits?all patients were marked by the score of NIHSS at admission,the moment after HT and discharge?,the therapy of antiplatelet aggregation drugs.Statistical methods:SPSS21.0 statistical software package was used to process the data,chi-square test was used for counting variables,and independent sample t test was used for measuring variables.Single factor analysis was used for each indicator,and then the risk factors with statistical significance were included in the Logistic regression model for multifactor analysis.Results:1.There were 100 cases in the HT group and 100 cases in the non-HT group.The univariate comparison of the baseline characteristics in the two groups showed that the difference of hospitalization days,low concentration of Ca²⁺,low level of low-density lipoprotein?LDL-C<2.07mmol/L?and high triglyceride?TG>1.7mmol/L?was statistically significant?P<0.05?.There was no significant difference in other single factors?P>0.05?.2.Logistic regression was performed on items with statistically significant difference in univariate analysis,and the results showed that compared with the normal level group,the low-density lipoprotein?LDL-C<2.07mmol/L?was lower than that in the normal level group,P<0.05,OR=3.613,the concentration of Ca2+,P<0.05,OR=0.035.The length of hospital stay in the HT group was significantly longer than that in the non-HT group?P<0.05?.3.Among the patients in the HT group,Logistic regression was applied.The independent variables included ECASS types?HI,PH?,TOAST types?LAA SUE?,NIHSS score at the moment after HT,thrapy,and the dependent variable was the short-term clinical outcome.Logistic regression was performed.The results showed that the PH subtype had statistically significant?P<0.05,OR=2.983?,and the NIHSS score had statistically significant?P<0.05,OR=1.159?.Conclusions:1.The low concentration of Ca²⁺,lower level of low-density lipoprotein?LDL-C<2.07mmol/L?were independent risk factors of HT.The patients with low concentration of Ca²⁺,lower level of low-density lipoprotein?LDL-C<2.07mmol/L?were easily lead to HT.2.After the occurrence of HT,the hospitalization time was significantly prolonged in patients with acute massive cerebral infarction,which increased the economic and time burden.3.The patients with acute massive cerebral infarction had high NIHSS score after HT and PHsubtype were likely to lead to adverse clinical outcomes and poor treatment efficiency.There was no significant correlation between the use of antiplatelet agents and clinical outcomes.