r-tPA静脉溶栓治疗急性脑梗死的远期疗效

The prostecdtive efficacy of actilyse intravenous thrombolysis in patients with acute cerebral infarction

目的评价重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗6h内急性脑梗死1年后的预后。方法对北京市级课题rt-PA静脉溶栓治疗急性脑梗死的206例病例以电话及家访形式进行1、2、3年的CSS神经功能及barthle生活指数的评分；对其有效率、死亡率、再梗死及致残率进行统计学分析。结果在前期入组的206例中有179例存活，42例失访，137例得到随访。其中1年显效率A组83．67％、B组91．67％、C组68．42％，溶栓组与C组有显著性差异；1年痊愈率A组53．06％、B组52．08％、C组31．57％。溶栓组与C组有显著性差异；1年死亡率A＋B组0、C组2．63％；1年死亡率＋致残率A＋B组4．12％、C组10．52％：2年显效率A组86．96％、B组89．13％、C组71．43％，溶栓组与C组有显著性差异；2年痊愈率A组56．52％、B组52．17％、C组31．43％，溶栓组与C组有显著性差异；2年死亡率A＋B组2．17％、C组2．86％；2年死亡率＋致残率A＋B组6．52％、C组11．43％；3年显效率A＋B组82．60％、C组71．43％；3年痊愈率A＋B组48．91％、C组31．43％；3年死亡率A＋B组2．17％、C组2．86％；3年死亡率＋致残率A＋B组11．96％、C组11．43％。各年各组的有效率、死亡率、死亡＋致残率无显著性差异。3年的痊愈率、显效率无显著性差异。再梗死率A＋B组13．40％、C组18．42％，统计学分析无显著性差异。0．7mg／kg与0．9mg／kg、低分子肝素与非低分子肝素组无显著性差异。结论rt-PA静脉溶栓治疗6h内脑梗死能改善2年内的预后。2年后的预后溶栓组与非溶栓组无差异。

Objective To evaluate the prostecdtive efficacy of Early Intravenous Thrombolysis using Actilyse （rt-PA） after one year in patients with acute cerebral infarction. Methods 137 of the 179 patients with acute cerebral infarction.after thrombolysis using Actilyse were followed up by telephone or home visit, the Chinese Stroke Scale （CSS） and Barthel Index （BI） were used to evaluate the neurological functions and life index in the one-year,two-years,three-years after the onset of strke. Results The significant effective rate of one-year in the group A, group B and group C were 83.67%,91.67% and 68.42%, there was lsignificant difference between group A＋B and group C ;the curative rate of one year in the group A , group B and group C were 53.06% ,52.08% and 31.57% ,there was significant difference between the group A＋B and group C ; the significant effective rate of two-year in group A, group B and group C were 86.96% ,89.13% and 71.43% ,there was significant difference between the group A＋B and group C ;the curative rate of two-year in the group A,group B and group C were 56.52%,52.17%,31.43% ,there was significant difference between the group A＋B and group C;there was no significant difference between the group A＋B and group C in the two-year effective rate,the three-year effective rate,the three-year significant effective rate and the three-year curative rate ;there was no significant difference between the group A＋B and group C in the one-year,two-year,three-year mortality rate, and no difference between group 0.7 mg/kg and 0.9 mg/kg,group Clexane and no Clexane.Condusion the benefit of thrombolytic therapy using rt-PA intravenously in patients with acute cerebral infarction within 6 hours could last two years, after then,there was no significant difference between group A＋B and group C.