急性后循环脑梗死不同时间窗静脉溶栓治疗的预后分析

The safety and efficacy of intravenous thrombolytic therapy for acute posterior circulation cerebral infarction within different time windows

目的探讨经磁共振证实的超急性期后循环梗死不同时间窗内,给予重组组织型纤溶酶原激活剂rt-PA治疗后的预后情况及安全分析。方法将32例经头部磁共振证实的后循环超急性期脑梗死患者按照溶栓治疗时间窗分组,分为〈4.5 h组16例,4.5~8 h组16例。所有患者在rtPA静脉溶栓前、溶栓后6 h、24 h、7 d分别进行美国国立卫生研究院卒中量表（NIHSS）评分,90 d时行Bathel指数（BI）、改良Rankin量表（mRS）评分,观察溶栓疗效及溶栓后脑出血的发生率。结果 〈4.5 h组与4.5~8 h组在各个时间点的NIHSS评分及90 d BI指数、mRS评分对比差异无统计学意义,溶栓后脑出血发生率亦无统计学意义。结论磁共振指导下的超急性期后循环脑梗死患者,适当延长时间窗进行静脉溶栓治疗安全有效。

[ Objective ] To investigate the safety and efficacy of intravenous thrombolytic therapy for acute posterior circulation cerebral infarction within different time windows. [ Methods ] Thirty-two acute posterior circulation cerebral infarction patients who confirmed by cephalic MRI were treated with rt-PA intravenous thrombolytic therapy. The time window〈4.5 h group were 16 cases ,4.5-8 h group were 16 cases respectively. The national institutes of health stroke scale （NIHSS） was assessed at pre-therapy and 6 h, 24 h, 7 d post therapy, Barthel Index （BI） and modified Rankin Scale （mRS） were assessed at 90 d after therapy. The efficacy and the rate of cerebral hemorrhage post therapy were compared between the 2 groups [ Resluts ] The scores of NHISS at each time point and Barthel Index （BI） and modified Rankin Scale （mRS） between 〈4.5 h group and 4.5-8 h group were no statistical difference. The rate of cerebral hemorrhage after therapy between the 2 groups was no statistical difference too. [ Conclusion ] The time window of intravenous thrombolytic therapy with rt-PA for acute posterior circulation cerebral infarction within 4.5 h or prolonging properly is effective and safe.