| 不同时间窗重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床分析 |
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| 引用本文： | 罗小春,龚文健,李敏辉. 不同时间窗重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床分析[J]. 中华全科医学, 2016, 14(5): 763-765. DOI: 10.16766/j.cnki.issn.1674-4152.2016.05.022 |
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| 作者姓名： | 罗小春 龚文健 李敏辉 |
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| 作者单位： | 中国人民解放军第九八医院神经内科, 浙江 湖州 313000 |
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| 摘 要： | 目的 探讨不同时间窗重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死患者的临床疗效。 方法 回顾性分析2013年10月—2015年10月收治的75例从发病至给药时间＜4.5 h的急性脑梗死患者的临床资料，其中从发病至给药时间＜3 h，且静脉给予rt-PA溶栓治疗患者24例(A组)，发病至给药时间3～4.5 h，且静脉给予rt-PA溶栓治疗患者30例(B组)，发病至给药时间＜4.5 h未溶栓而常规治疗患者21例(对照组)，分别在治疗前、治疗后24 h、7 d 三个时间点分析比较其NIHSS 评分，并在治疗后7 d对3组的临床疗效、颅内出血及死亡情况进行评估。 结果 A组、B组治疗后24 h、7 d的NIHSS评分显著低于治疗前(t≥3.38，均P＜0.05)，也显著低于对照组治疗后(t≥3.42，均P＜0.05)；A组、B组治疗后24 h、7 d的NIHSS评分比较差异无统计学意义(t=0.81、0.99，均P＜0.05)。A组、B组治疗后7 d的有效率显著高于对照组(χ2=11.667、11.286，P＜0.05)，但A组、B组的有效率比较差异无统计学意义(χ2=0.098，P＞0.05)。A组、B组的病死率显著低于对照组(χ2=3.780、4.989，P＜0.05)，但A组、B组的病死率比较差异无统计学意义(χ2=0.026，P＞0.05)。B组的颅内出血率显著高于A组，差异具有统计学意义(χ2=3.881，P＜0.05)。 结论 发病3～4.5 h和＜3 h进行rt-PA溶栓临床疗效均显著，但时间窗的延长可导致颅内出血的风险增加，但死亡风险未增加，对发病4.5 h内的急性脑梗死患者应当积极给予rt-PA静脉溶栓治疗。
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| 关 键 词： | 重组组织型纤溶酶原激活剂 溶栓治疗 急性脑梗死 时间疗法 |
| 收稿时间： | 2015-12-31 |
Clinical analysis of recombinant tissue plasminogen activator combined with thrombolytic therapy in treatment of acute cerebral infarction(ACI) |
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| Affiliation: | Neurology department in the 98th Chinese people’s liberation army,Huzhou,Zhejiang 313000,China |
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| Abstract: | Objective To discuss the curative effects of recombinant tissue plasminogen activator combined with thrombolytic therapy in treatment of acute cerebral infarction(ACI). Methods From January,2013 to October,2015,clinical data of 75 ACI patients in our hospital were retrospectively analyzed from morbidity to give medicine<4.5 h,of which 24 patients were given medicine<3 h(Group A),30 cases were given medicine 3-4.5 h(Group B),and 21 cases were given medicine<4.5 h.And respectively in 24 h before and after treatment,7 days after treatment the NIHSS score,clinical efficacy intracranial hemorrhage and death of the three groups were evaluated. Results After treatment for 24 h and 7 d,the NIHSS scores in group A and group B were significantly lower than before treatment(t≥3.38,all P<0.05),and significantly lower than that in the control group after treatment(t≥3.42,P<0.05);After treatment for 24 h and 7 d,the NIHSS score comparison difference in group A and group B had no statistical significance(t=0.81,0.99,P<0.05).In group A and group B,7 d efficient rate was significant higher than that in the control group after treatment(χ2=11.667,11.286，P<0.05),but in group A and group B the efficient rate had no statistically significant difference(χ2=0.098,P>0.05).The mortality in group A and group B was significantly lower than that in the control group,but the death rate of group A and group B had no statistically significant difference(χ2=0.026，P>0.05).In group B intracranial hemorrhage rate was significantly higher than that in group A,which had statistically significant difference(χ2=3.881,P<0.05). Conclusions It has significant clinical efficacy by using rt-PA thrombolysis 3-4.5h and <3h after morbidity,however,the extension of time window can lead to an increased risk of intracranial hemorrhage,which doesn’t increase the risk of death;And in patients with acute cerebral infarction within 4.5h of stroke onset should be also actively given rt-PA intravenous thrombolysis treatment. |
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