小剂量阿替普酶在醒后卒中溶栓治疗中的效果分析

Efficacy of low-dose human recombinant tissue-type plasminogen activator(rt-PA)in thrombolytic therapy for wake-up stroke patients

目的分析小剂量阿替普酶在醒后卒中(WUS)患者溶栓治疗中效果。方法选择2015年11月至2020年11月温岭市第一人民医院收治的急性WUS患者116例,依据MRI检查结果分为观察组[弥散加权成像(DWI)(+)/液体衰减反转恢复成像(FLAIR)(-),34例]及对照组[DWI(+)/FLAIR(+),82例],在血管评价的基础上按TOAST分型分为5个亚型,对照组给予常规抗血小板聚集、降脂、改善循环及防治并发症等治疗,观察组在对照组基础上给予小剂量阿替普酶(0.6 mg/kg)溶栓治疗。评估并比较观察组与对照组的第30天的美国国立卫生院卒中量表(NIHSS)评分,两组患者及各亚型的显效率、总有效率。结果观察组与对照组的NIHSS评分治疗后均较治疗前改善,且观察组NIHSS评分低于对照组,显效率、总有效率均优于对照组,差异均有统计学意义(均P<0.05)。治疗后,观察组S、L亚型NIHSS评分均低于对照组,且均低于治疗前,观察组S、L亚型的显效率、总有效率均高于对照组,差异均有统计学意义(均P<0.05)。结论对于FLAIR(-)的WUS患者,影像学评估后给予小剂量阿替普酶溶栓治疗,可以改善S及L亚型脑梗死患者的临床预后。

Objective To evaluate the efficacy of low-dose human recombinant tissue-type plasminogen activator(rt-PA)in thrombolytic therapy for wake-up stroke(WUS)patients.Methods A total of 116 patients with WUS were admitted in Wenling First People's Hospital from November 2015 to November 2020 were enrolled in the study.According to MRI scanning patients were divided into two groups:82 patients with DWI(+)/FLAIR(+)received anti-platelet aggregation,lipid-lowering,circulation improvement and complications prevention and treatment(control group)and 34 patients with DWI(+)/FLAIR(-)received low dose of rt-PA(0.6 mg/kg)thrombolytic therapy in addition to conventional treatment(study group).The vascular evaluation was performed with MRA and patients were divided into 5 sub-types based on TOAST classification.The NIHSS scores were assessed in the two groups before and 30 days after treatment,the significant efficacy and total effective rate of treatment was evaluated in patients with different sub-types of TOAST classification.Results The NIHSS scores were improved after treatment in both groups,while the NIHSS scores in study group were lower than those in the control group.The significant efficacy and total effective rate of the study group were better than those of the control group(P<0.05).The NIHSS scores after treatment of sub-types small-artery atherosclerosis(S)and large-artery atherosclerosis(L)in the study group were lower than those in the control group(P<0.05),while there was no statistical significance in patients with sub-type C between study group and control group(P>0.05).The significant efficacy and total effective rate of sub-types S and L in the study group were higher than those in the control group(P<0.05).Conclusion For FLAIR(-)WUS patients,radiographic assessment followed by low dose of rt-PA can improve the clinical outcomes with subtype S and L cerebral infarction.