高龄急性脑梗死患者时间窗内rt-PA静脉溶栓治疗的对照研究

Comparative study of rt -PA intravenous thrombolytic therapy within time window for senility patients with acute cerebral infarction

目的观察临床高龄急性脑梗死患者时间窗内重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的效果。方法选取本院2009年2月～2012年12月收治的45例高龄急性脑梗死患者按患者或家属溶栓治疗意愿分为溶栓组20例,非溶栓组25例。非溶栓组给予常规抗血小板聚集等治疗,溶栓组在常规治疗的基础上应用rt-PA溶栓剂进行治疗,比较两组患者溶栓前后美国国立卫生院卒中量表(NIHSS)评分及溶栓后3个月日常生活能力(ADL)评分。结果治疗前两组患者的NIHSS评分比较,差异无统计学意义(P>0.05),治疗后两组患者的NIHSS评分比较,差异有统计学意义(P<0.01);溶栓后3个月的ADL比较,溶栓组评分优于非溶栓组,差异有统计学意义(P<0.01);两组患者均有颅内出血现象发生,溶栓组发生率高于非溶栓组,差异有统计学意义(P<0.01);两组死亡率比较,差异无统计学意义(P>0.05)。结论高龄急性脑梗死患者时间窗内rt-PA静脉溶栓治疗是改善患者预后的有效方法,但颅内出血可能性增大。

Objective To observe the therapeutic effect of recombinant tissue-type plasminogen activator（rt-PA） intra venous thrombolytic therapy within time window for senility patients with acute cerebral infarction.Methods Forty five senility patients with acute cerebral infarction admitted to our hospital from February 2009 to December 2012 were as signed into thrombolytic group（20 cases） and non-thrombolytic group（25 cases）,according to the desire of patients or their family member.The non-thrombolytic group was treated by conventional anti-platelet aggregation therapy,while the thrombolytic group by rt-PA thrombolytic therapy on the basis of conventional therapy.The US National Institutes of Health Stroke Scale（NIHSS） score and activities of daily life（ADL） score in 3 months after thrombolytic of patients in two groups were compared before and after thrombolytic therapy.Results The NIHSS scores of patients in two groups showed no significant difference（P0.05）before treatment,but there was statistically significant difference（P 0.01） after treatment.The ADL score of thrombolytic group was higher than that of non-thrombolytic group in 3 months after thrombolytic therapy with significant difference（P0.01）.Intracranial hemorrhage occurred in two groups,the occurrence rate of thrombolytic group was higher than that of non-thrombolytic group with significant difference（P 0.01）.The comparison of mortality in two groups had no significant difference（P0.05）.Conclusion The rt-PA intravenous thrombolytic therapy within time window for senility patients with acute cerebral infarction is an effective method of improving prognosis of patients,but may increase the possibility of intracranial hemorrhage.