急性脑梗死不同时间窗内阿替普酶静脉溶栓治疗效果

Effect of Intravenous Thrombolytic Therapy with Alteplase in Different Time Windows of Acute Cerebral Infarction

目的 :探讨急性脑梗死(ACI)不同时间窗内阿替普酶静脉溶栓治疗效果及对患美国国立卫生院神经功能缺损评分(NIHSS)的影响。方法 :选取2016年8月—2017年10月我院神经内科急诊收治的ACI患者84例,根据溶栓时间窗进行分组,发病<3 h溶栓的42例作为对照组,发病3～4.5 h溶栓的42例作为试验组,两组均采用阿替普酶(使用剂量为0.9 mg/kg,最大剂量不超过90 mg)行静脉溶栓治疗,比较两组疗效、NIHSS及不良反应。结果 :对照组治疗总有效率为90.48%,试验组治疗总有效率为92.86%,两组比较差异无统计学意义(P> 0.05);两组在溶栓前NIHSS评分比较,差异无统计学意义(P> 0.05),两组溶栓后24 h、3 d、7 d的NIHSS评分均较溶栓前明显降低,差异有统计学意义(P <0.05),但溶栓后两组比较差异无统计学意义(P> 0.05);对照组不良反应发生率为19.05%,试验组为21.43%,两组比较,差异无统计学意义(P> 0.05)。结论 :ACI在发病<3 h、3～4.5 h时间窗内应用阿替普酶静脉溶栓均可获得较好的治疗效果,可显著降低NIHSS评分,改善预后,且安全性较好。

Objective:To investigate the effect of intravenous thrombolytic therapy with alteplase in different time windows of acute cerebral infarction(ACI)and its influence on the scores of national institutes of health neurological deficit scale(NIHSS)of the patients.Methods:84 patients with ACI admitted to the Department of Neurology in our hospital from August 2016 to October 2017 were selected and divided into two groups according to the time window of thrombolysis,42 patients undergoing thrombolysis less than 3 hours after attack as a control group,and 42 patients undergoing thrombolysis 3~4.5 hours after attack were treated as an experimental group.The patients in the two groups were given intravenous thrombolytic therapy with alteplase(the dose was 0.9 mg/kg and the maximum dose was not more than 90 mg).The effcacy,the scores of NIHSS and adverse reactions were compared between the two groups.Results:The total effective rate in the control group was 90.48%,and the total effective rate in the experimental group was 92.86%,so there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in the scores of NIHSS before thrombolysis between the two groups(P>0.05).The scores of NIHSS in two group at 24 h,3 days and 7 days after thrombolysis were significantly lower than those before thrombolysis,and the differences were statistically significant(P>0.05).However,there was no statistically significant difference in the scores of NIHSS after thrombolysis between the two groups(P>0.05).The incidence of adverse reactions in the control group was 19.05%,and that in the experimental group was 21.43%,so there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Intravenous thrombolysis with alteplase in the time window of less than 3 h,3~4.5 h after attack of ACI can achieve better curative effect,significantly reduce the scores of NIHSS and improve prognosis,and has better safety.