不同方案治疗急性脑梗死伴意识障碍患者的对比研究

A comparison study of acute ischemic stroke with disorders of consciousness

目的探讨rt-PA静脉溶栓和抗血小板聚集治疗急性脑梗死伴意识障碍患者的疗效和安全性。方法急性脑梗死伴意识障碍患者按照不同的治疗方案分为两组:抗血小板聚集组32例,口服拜阿司匹林0.3g/d;rt-PA静脉溶栓组24例,予rt-PA 0.9mg/Kg,最大剂量90mg。分别在治疗前和治疗后24小时和14、90天行NIHSS评分,90天行OHS评分,比较两组疗效;观察两组治疗后24小时和14、90d的死亡事件发生率和死亡原因;比较两组不同意识障碍程度患者14天的存活率。结果治疗后两组各时间点NIHSS评分和90天OHS评分rt-PA组较抗血小板聚集组下降,并且昏迷亚组14天存活率高于抗血小板聚集组,差异均有统计学意义(P<0.05);死亡事件发生率两组间差异无统计学意义(P>0.05)。结论 rt-PA静脉溶栓治疗重症急性脑梗死伴意识障碍患者安全、有效,可在临床推广应用。

Objective To investigate the effects and safety of intravenous thrombolytic therapy with rt-PA and an- ti-platelet for acute ischemic stroke with consciousness disorders. Methods 32 cases were included in anti-platelet group and treated with 0.3g/d by oral. The rt-PA group included 24 cases with 0. 9mg/Kg rt-PA by intravenous and the maxi- mum dose was 90rag. The national institutes of health stroke scale （NIHSS） were used to assess neurological function at pre-treatment and 24h, 14d, 90d after treatment. Oxford Handicap Scale （OHS） was scored at 90d after therapy. The efficacy was compared between the two groups. Mortality and causes were observed at 24h, 14d and 90d post therapy. Survival rate of coma subgroup were compared at post-therapy 14d. Results The scores of NIHSS at each time point or OHS at 90d of rt-PA group were lower than that of the anti-platelet group, and survival rate of coma subgroup at 14d was higher than the anti-platelet group. All of these scores had statistical difference between the two groups. Mortal rate had no statistical difference between the two groups. Conclusion Intravenous thrombolytic therapy with rt-PA for acute is- chemic stroke with consciousness disorder is effective and safe.