| 丁凤玲,张仲慧,康 宏,韩 丹,李敏丽,常 悦.重组组织型纤溶酶原激活剂静脉溶栓治疗发病4.5小时内急性脑梗死近期疗效的回顾性研究[J].,2022,(2):392-396 |
| 重组组织型纤溶酶原激活剂静脉溶栓治疗发病4.5小时内急性脑梗死近期疗效的回顾性研究 |
| Retrospective Study on the Short-Term Efficacy of rt-PA Intravenous Thrombolysis in the Treatment of Acute Cerebral Infarction within 4.5 Hours after Onset |
| 投稿时间：2021-04-06 修订日期：2021-04-30 |
| DOI：10.13241/j.cnki.pmb.2022.02.038 |
| 中文关键词: 急性脑梗死 重组组织型纤溶酶原激活剂 静脉溶栓 疗效 |
| 英文关键词: Acute cerebral infarction Recombinant tissue plasminogen activator Intravenous thrombolysis Efficacy |
| 基金项目:国家自然科学基金项目（81801173）；辽宁省自然科学基金项目（20180550891） |
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| 中文摘要: |
| 摘要 目的：研究发病4.5小时内的急性脑梗死患者早期应用重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗的临床效果。方法：回顾性分析2018年07月1日到2020年10月31日我院神经内科收治的发病在4.5小时内的652例急性脑梗死患者的临床资料，其中使用rt-PA静脉溶栓治疗的患者285例为溶栓组，未溶栓仅使用抗血小板聚集、他汀类降脂、脑保护等常规治疗的患者367例为对照组。记录两组患者治疗前及治疗后24小时、7天、14天的美国国立卫生研究院卒中量表(NIHSS)评分和治疗3个月后的改良Rankin量表（mRS）评分。对于有吞咽障碍的患者，收集洼田饮水试验结果。统计两组患者出血情况和死亡率。结果：溶栓组治疗后24小时、7天、14天的NIHSS评分以及治疗后3个月的mRS评分改善明显，与对照组相比，差异有统计学意义（P<0.05）；对于有吞咽障碍的患者，溶栓组的治疗有效率高于对照组（P<0.05）；溶栓组轻微出血的概率大于对照组（P<0.05）；两组在症状性及致死性脑出血方面的差异无统计学意义（P>0.05）；溶栓后大量及致死性脑出血部位多在梗死的中心区、出血量多大于10 mL，患者临床NIHSS评分≥24分。溶栓组死亡率较对照组下降（P＜0.05）。结论：发病4.5小时内的急性脑梗死患者接受rt-PA静脉溶栓治疗的近期治疗效果良好，轻微出血风险较高，但是死亡率下降。临床神经功能缺损重、NIHSS评分≥24分、出血风险大的患者预后不良，不推荐溶栓治疗。 |
| 英文摘要: |
| ABSTRACT Objective: To study the clinical effect of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in the early stage of acute cerebral infarction within 4.5 hours after onset. Methods: The clinical dataes of 652 patients with acute cerebral infarction who were admitted to the Department of Neurology of our hospital within 4.5 hours after onset from July 1, 2018 to October 31, 2020 were retrospectively analyzed. Among them, 285 patients receiving intravenous thrombolytic therapy with rt-PA were included in the thrombolytic group, while 367 patients without thrombolytic therapy were included in the control group who only received conventional treatment such as antiplatelet aggregation, statin lipid-lowering, and brain protection. The National Institutes of Health Stroke Scale (NIHSS) scores of two groups before treatment and 24 hours, 7 days and 14 days after treatment, and the modified Rankin Scale (MRS) scores at 3 months after treatment were recorded. For patients with dysphagia, the results of drinking water test were collected. The bleeding and mortality of the two groups were statistically analyzed. Results: The NIHSS score of 24 hours, 7 days and 14 days after treatment and mRS score at 3 months after treatment in thrombolytic group were significantly improved, compared with the control group, the difference was statistically significant(P<0.05). For patients with dysphagia, the effective rate of thrombolytic group was higher than that of the control group(P<0.05). The probability of mild hemorrhage in thrombolytic group was higher than that of the control group(P<0.05). There was no significant difference in symptomatic and fatal cerebral hemorrhage between the two groups (P>0.05). After thrombolysis, the site of massive and fatal intracerebral hemorrhage was mostly in the central area of infarction, the amount of bleeding was more than 10 mL, and the clinical NIHSS score of patients ≥24 scores. The mortality of thrombolytic group was lower than that of control group(P<0.05). Conclusion: Patients with acute cerebral infarction within 4.5 hours after onset who received intravenous rt-PA thrombolysis has a good short-term treatment effect, the risk of slight bleeding is higher, but the mortality is reduced. Patients with severe clinical neurological impairment, NIHSS score ≥ 24 scores, high risk of bleeding have poor prognosis, thrombolytic therapy is not recommended. |
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