重组组织型纤溶酶原激活剂超早期静脉溶栓治疗急性脑梗死的疗效观察

Therapeutic effect observation of thrombolysis with rt-PA intravenous in hyper acute cerebral infarction

目的探讨重组组织型纤溶酶原激活剂(rt-PA)超早期静脉溶栓治疗急性脑梗死(ACI)的疗效及安全性。方法对74例发病<6h的ACI患者给予rt-PA(50mg)静脉溶栓治疗,溶栓前及溶栓后30min、24h、14d及3个月时分别采用美国国立卫生院卒中量表(NIHSS)评分,以及溶栓后3个月给予修订的Rankin评分(mRS)和日常生活能力Barthal指数(BI)评分,评价其疗效及安全性。结果溶栓后各时间点NIHSS评分均有明显改善(均P<0.01);3个月时NIHSS≤1分者31例(41.9%),mRS0～1分者39例(52.7%),BI95～100分者33例(44.6%)。脑出血发生率:<36h5例(6.8%),36～72h3例(4.1%)。3个月内死亡9例(12.2%)。结论ACI发病6h内给予rt-PA静脉溶栓治疗相对安全有效。

Objective To assess the efficacy and safety of thrombolysis with rt-PA intravenous in hyper acute cerebral infarction（ACI）. Methods 74 patients within 6 hours after the onset of stroke were enrolled in our trial and every patient was given rt-PA 50mg intravenously. The NIHSS scores were used before thrombolysis and at 30 min, 24 h, 14 d, 3 months after thrombolysis. At 3 months, the mRS score, BI scale, the incidence of symptomatic intracranial hemorrhage （slCH） and the mortality were calculated to assess the efficacy and safety. Results The NIHSS scores were improved at each time point （ all P 〈0. 01 ）. At 3 months, there were 31 patients （41.9%） with low NIHSS score （ ≤1 ）, 39 patients （52. 7% ） with low mRS （0 - 1 ） and 53 patients （44.6%） with high BI scale （95 - 100）. The rate of ICH was 6.8% （5 cases） within 36 h and 4.1% （3 cases） during 36 h -72 h. 9 patients （ 12.2% ） died within 3 months. Conclusion ACI patient given 50 mg of rt-PA within 6 hours of onset is efficient and safe.