重组组织型纤溶酶原激活剂静脉溶栓治疗老年急性脑梗死临床研究(附40例分析)

Clinical study on rt-PA intravenous thrombolysis for aged patients with acute cerebral infarction

目的观察重组组织型纤溶酶原激活剂 ( rt-PA)静脉溶栓早期治疗老年急性脑梗死的疗效和安全性。方法急性脑梗死 40例 (发病时间 <6小时 )分为两组 :≥ 70岁组 ( A组 15例 )和 <70岁组 ( B组 ,2 5例 )。选用艾通立 5 0 mg,先于 2分钟内静脉注射 rt-PA 8mg,再将 42 mg于 1小时内静脉泵入 ,两组其它治疗均相同。评定指标包括治疗前、治疗后 2 4小时、30天的临床神经功能缺损程度评分 ;治疗后 30天的 Barthel指数及死亡情况、副作用。结果治疗前、治疗后 2 4小时、30天的临床神经功能缺损程度评分 :A组分别为 18±2 .4、13.2± 3、6.9± 2 ;B组分别为 17.5± 2 .0、11.4± 2、6.8± 2 .5 ;两组比较无显著性差异 ( P>0 .0 5 ) ;30天时的 Barthel指数评分 :A组为 86.5± 9.0、B组为 85 .4± 8.0 ,两组比较无显著性差异 ( P>0 .0 5 ) ;两组溶栓治疗后 Fb水平比较无显著性差异 ( P>0 .0 5 ) ,没有增加出血事件及其它副作用。两组病死率分别为 13.3%、8.0 % ,两组比较无显著性差异 ( P>0 .0 5 )。结论急性脑梗死早期应用 rt-PA静脉溶栓治疗是安全有效的 ;高龄 (≥ 70岁 )患者接受 rt-PA治疗安全有效。应用 rt-PA静脉溶栓治疗急性脑梗死不是绝对禁忌 。

Objective To evaluate the safety and efficacy of rt PA intravenous thrombolysis in the aged patients with acute cerebral infarction.Methods 40 cases of acute cerebral infarction [within 6 hours from the onset of stroke were divided into group A (≥70 years old, [WTBX]n=15)] and group B (≤ 69 years old, and group B (≤ 69 years old, n=25). 8 mg actilyse (rt PA) was injected intravenously in 2 minutes, and then 42 mg rt PA was infused in 1 hour for both groups. Scoring of clinical nerve function, Barthel index, mortality and side effects were evaluated before treatment, 24 hours and 30 days after treatment.Results Scoring of clinical nerve function before treatment, 24 hours and 30 days after treatment were 18±2.4, 13.2±3.0, 6.9±2.0 in group A, and 17.5±2.0,11.4±2.0, 6.8±2.5 in group B separately, with no significant differences (P>0.05). Barthel index at 30 days after treatment were 86.5±9.0 in group A and 85.4± 8.0 in group B, without significant differences (P>0.05).Conclusion Early application of rt PA intravenous thrombolysis is safe and effective for aged patients with acute cerebral infarction