爱通立溶栓治疗急性脑梗死出血性转化临床疗效观察

Clinical observation of Actilyse in treatment of acute cerebral infarction with hemorrhage

目的探讨并评价应用rt-PA治疗6h内急性脑梗死出血性转化的临床意义及相关影响因素。方法将满足入选标准的209例患者随机分成3组,其中甲组给予0.9 mg/kg的rt-PA;乙组给予0.7 mg/kg的rt-PA;丙组为对照组,同时将3组又分成克赛亚组(甲1、乙1、丙1)与非克赛亚组(甲2、乙2、丙2)。通过CSS与BI对溶栓前、溶栓后24 h、3 d、7 d、90 d的疗效进行评价。结果甲组与乙组的总出血发生率、48 h脑出血率以及14d脑出血总出血率均高于丙组,差异显著(P<0.05)。甲组、乙组与丙组在症状性脑出血率方面比较无显著差异(P>0.05)。甲组与乙组的90 d显效率以及90 d痊愈率均高于丙组,差异显著(P<0.05)。甲组与乙组的90 d病死率均低于丙组,差异显著(P<0.05)。甲组与乙组的上述各分析结果之间无显著差异(P>0.05),克赛亚组和非克赛亚组之间比较,无显著差异(P>0.05)。结论应用rt-PA进行静脉溶栓6h内将增加急性脑梗死出血几率,但可以增强治疗效果并减低病死率,提示应用rt-PA在6h内静脉溶栓在治疗急性脑梗死方面的是可行的,应用剂量以0.7mg/kg为宜。

Objective To explore and evaluate the clinical significance and relevant influencing factors of the application of Actilyse（rt-PA）in the treatment of 6 h acute cerebral infarction wutg hemorrhage.Methods Meet the criteria for inclusion of 209 patients were divided randomly into three groups,A group were given 0.9 mg/kg rt-PA;B group were given 0.7 mg/kg rt-PA;C group as control group,while the three groups were divided into G Messiah group（A1,B1,C1） and non G Messiah group（A2,B2,C2）.Through CSS and BI on thrombolytic therapy after thrombolysis,24 h,3d,7d,90d efficacy evaluation.Results The group A and B of the total incidence of bleeding,48h and 14d total cerebral hemorrhage rates were higher than those of group C,there is significant difference（P0.05）.Group A,B and C group in symptomatic intracranial hemorrhage rate had no significant difference（P0.05）.Group A and B of the 90 d significant efficiency and 90d recovery rate were higher than those in group C,there is significant difference（P0.05）.Group A and B of the 90 d fatality rates were lower than C group,there is significant difference（P0.05）.Group A and B above all between analytical results had no significant difference（P0.05）,G Messiah greup and non G Messiah group were compared between groups,there is no significant difference（P0.05）.Conclusions The application of rt-PA for intravenous thrombolysis in acute cerebral infarction 6h will increase bleeding risk,but can enhance the therapeutic effect and reduce the case fatality rate,prompt application of rt-PA in 6h intravenous thrombolysis in treatment of acute cerebral infarction area is feasible,the applied dose to 0.7 mg/kg suitable.