急性脑梗死动脉溶栓血管再通后重组组织型纤溶酶原激活剂用法探讨

Effects of inter-arterial thrombolysis for acute ischemic stroke by different ways of recombinant tissue plasminogen activator after revascularization

目的探讨急性脑梗死动脉溶栓血管再通后重组组织型纤溶酶原激活剂(r-tPA)用法。方法选取北京世纪坛医院2007年1月-2012年6月以急性脑梗死入院进行动脉溶栓血管再通的患者93例,随机分为试验组(49例)和对照组(44例),试验组患者继续使用r-tPA达最高批准剂量(22 mg),对照组则停止溶栓。对入选患者进行为期90 d的随诊,收集其在该时间段内是否发生继发性脑出血、血管再闭塞等不良反应,并进行NIHSS量表、改良Rankin量表(mRS)评估。结果治疗后24 h试验组NIHSS评分较对照组明显降低[(3.72±4.80)分比(6.24±4.80)分,P=0.041]。在治疗后90 d时,试验组mRS评分预后良好者较对照组增多(87.7%比72.7%,P=0.022)。结论急性脑梗死动脉溶栓血管再通后继续使用r-tPA直到22 mg是安全有效的。

Objective To investigate the effects of intra-arterial thrombolysis for acute ischemic stroke by different treatment after revascularization.Methods 93 cases of ultra-acute ischemic stroke patients without visible angiograph ic occlusion on digital subtraction angiogram during intra-arterial thrombolysis of Beijing Shijitan Hospital from Jan uary 2007 to June 2012 were randomized into two group.The control group（44 cases） end recombinant tissue plas minogen activator（r-tPA） intra-arterial thrombolysis and the treatment group（49 cases） continues to r-tPA intra-arte rial thrombolysis until highest approved dose（22 mg）.90 d after thrombolysis,National Institutes of Health Stroke Scale scores and modified Rankin Scores（mRS） for prognosis were evaluated for the patients.The situation of neuro logic impairment between groups was judged by NIHSS.The prognosis of neurologic function was evaluated by mRS.Results 24 h after thrombolysis,the treatment group showed a statistically significant decrease in NIHSS score [（3.72 ± 4.80） scores vs（6.24±4.80） scores,P=0.041] and had significant higher rates of the favorable outcome indicated by the mRS（87.7% vs 72.7%,P=0.022） at 90 days than the control group.Conclusion The effects of continuation intraarterial thrombolysis by r-tPA for acute Ischemic Stroke after revascularization is significant and safe.