急诊院前溶栓治疗急性脑梗死的疗效分析

Clinical efficacy of prehospital thrombolytic treatment in emergency patients with acute cerebral infarction

目的探讨急诊科应用重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗急性脑梗死(ACI)的临床疗效。方法选择2011年2月～2012年7月在急诊科就诊的ACI患者79例,随机分为两组,对照组39例采用常规治疗,溶栓组40例在对照组基础上给予rt-PA静脉溶栓治疗,观察比较两组患者治疗效果,治疗前及治疗后1天、14天、30天的脑卒中量表评分(NIHSS),治疗后1个月和2个月时的日常生活能力Barthel指数及并发症发生率。结果溶栓组总有效率为92.50%,对照组总有效率为76.92%,两组疗效比较,差异有统计学意义(P<0.05);两组治疗后NIHSS、Barthel评分均较治疗前明显改善,差异有统计学意义(P<0.05或<0.01),溶栓组的改善程度优于对照组,差异有统计学意义(P<0.01);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论 rt-PA急诊院前静脉溶栓治疗急性脑梗死疗效确切,安全,明显改善患者预后,值得临床推广应用。

Objective To explore the curative effect of intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）in treating patients with acute cerebral infarction（ACI） in the emergency department. Methods 79 patients with acute cerebral infarction, who were admitted to our hospital from Feb,2011 to Jul,2012,were randomly divided into the thrombolysis group（ n = 40）and the control group（ n = 39）. The thrombolysis group was treated with rt-PA intravenous thrombolytic therapy based on routine therapy,while the control group was given routine therapy only. Observe the curative effect of these two groups as well as the scores of National Institutes of Health Stroke Scale（NIHSS） of brain stroke before treatment and on day 1 ,day 4,day 30 after treatment. The Barthel index （BI）of daily living ability and the complication incidence before treatment, 1 month and 2 month after treatment were also observed and compared between the two groups. Results The total effective rate（92.50%） of the thrombolysis group was significantly higher than that（76.92 %） of the control group. So the difference was statistically significant （ P 〈0.05 or 〈0.01）. The scores of NIHSS and Barthel after treatment were significantly better than those before treatment in both groups, so the difference was statistical significance （ P 〈 0. 05）. In addition, the thrombolysis group had significantly better scores of NIHSS and Barthel than those of the control group after treatment, so there was significant difference（ P 〈0.05 or 0.01 ）. However,there was no significant difference in complications between the two groups（ P 〉0.05）. Conclusion Rt-PA intravenous tbrombolytic therapy is effective and safe in treating patients with acute cerebral infarction. It can significantly improve the prognosis of patients and is worthy of clinical popularization and application