急诊超时间窗溶栓治疗急性脑梗死的临床研究

Clinical study of extending thrombolytic time window in the therapy of acute cerebral infarction by emergency treatment

目的评价急诊超时间窗（4．5～9．0h）静脉应用重组组织型纤溶酶原激活剂（rt—PA）溶栓治疗急性脑梗死的疗效及安全性。方法将60例急性脑梗死患者分为常规治疗组（A组）、rt—PA溶栓组（B组），各组按静脉干预时间再分为〈4．5h亚组及4．5～9．0h亚组。A组给予常规治疗；B组给予rt—PA静脉溶栓和常规治疗。治疗前急诊行头颅CT和多模式MRI检查，治疗后24h复查头颅CT，分别于治疗前后不同时间点进行NIHSS神经功能缺损评分，记录不良事件。结果B组两个亚组NIHSS评分显著低于A组亚组（P〈0．05），且B组两个亚组治疗后24hNIHSS评分较治疗前垃著下降（P〈0．05）；B组〈4．5h亚组NIHSS评分显著低于B组4．5～9．0h亚组（P〈0．05）；各组无严重不良事件发生。结论急诊〈4．5h静脉应用rt—PA溶栓疗效确切，多模式MRI指导下急诊超时间窗（4．5～9．0h）静脉溶栓安全有效。

Objective To investigate the efficacy and safety of extending thrombolytic time window （4.5 - 9.0 h） of recombinant tissue - type plasminogen activator （ rt - PA） in therapy of acute cerebral infarction by emergeney treatment. Methods 60 patients were divided into routine group （ group A） with normal drugs and rt - PA group （ group B） with intravenous injection of rt - PA （ 0. 9 mg/kg） and normal drugs. Each group was divided into two subgroups depending on the onset time. Head CT/muhimode MR and NIHSS were assessed before and after treatment. The occurrence of the secondary intraeranial hemorrhage and death were record to assess safety. Results The scores were lower in two subgroups of group B than those in two subgroups of group A, and the 24 - hour scores decreased obviously in two subgroups of group B. The scores of less than 4.5 h onset group was lower than those of 4.5 - 9.0 h group in group B. There were no serious side effects. Conclusion Method of expanding thrombolytic time window of rt - PA in acute cerebral infarction was safety and efficacy.