重组组织型纤溶酶原激活剂静脉溶栓治疗心源性脑栓塞的临床研究

Study of thrombolytic therapy with intravenous recombinant tissue-type plasminogen activator for cardiogenic cerebral embolism

目的探讨重组组织型纤溶酶原激活剂(rt-PA)治疗急性心源性脑栓塞(CCE)的安全性及疗效。方法符合入选标准的患者溶栓组19例,对照组21例,发病3h内给予rt-PA(0.9 mg/kg)静脉溶栓治疗,采用美国国立卫生院神经功能缺损评分及Barthel指数,评定溶栓前及溶栓后2、6 h、1、3、7、30、90 d的疗效及安全性。结果溶栓后各时间点NIHSS评分均有显著改善(P<0.05),溶栓组临床总有效率89.5%,对照组38.1%。溶栓组脑出血发生率为10.5%,其中症状性脑出血发生率5.26%。对照组脑出血发生率19%,其中症状性脑出血发生率4.76%。溶栓组病死率0,对照组病死率9.5%。结论 CCE患者3 h内给予rt-PA静脉溶栓治疗是安全有效的。

Objective To investigate the safety and efficacy of thrombolysis with recombinant tissue type plasminogen activator （rtPA） in the treatment of acute cardiogenic cerebral embolism （CCE）. Methods 19 cases were included in the thrombolysis group, and 21 cases in the control group. In the thrombolysis group, the patients within an onset within 3 hours were given rtPA （0. 9 mg/kg） for intravenous thrombolytic therapy, using neurological deficit score of National Institutes of Health in the U. S. and Barthel index, so as to assess the efficacy and safety before thrombolysis and 2 h, 6 h, 1 d, 3 d, 7 d, 30 d, 90 d respectively after thrombolysis. Results After thrombolysis, NIHSS scores at each time point are significantly improved （P〈 0. 05）, and the total clinical effective rate was 89. 5G; while there was 38. 1G in the control group. The in tracerebral hemorrhage rate in thrombolysis group was 10. 5%,5.26% of which was symptomatic intracranial hemorrhage rate. Meanwhile, the intracerebral hemorrhage rate in the control group was 19%, with symp tomatic intraeranial hemorrhage rate of 4. 76%. Thrombolysis mortality in the thrombolysis group was 0, while mortality rate of the control group was 9. 5 %. Conclusions It could be safe and effective for patients with CCE to receive intravenous thrombolysis with rtPA within 3 hours of the onset.