阿替普酶超时间窗溶栓治疗急性脑梗死37例临床分析

Thrombolysis with alteplase in broadened therapeutic time window for acute cerebral infarction in 37 cases

目的探讨阿替普酶超时间窗溶栓治疗急性脑梗死的安全性和有效性。方法 99例急性脑梗死患者依据治疗方法不同分为溶栓组52例和对照组47例,并依据溶栓治疗时间将溶栓组分为2个亚组,发病时间〉4.5~7.0h37例为溶栓A组,≥3.0~4.5h15例为溶栓B组;溶栓A、B组均给予阿替普酶溶栓治疗,对照组应用拜阿司匹林及活血化瘀药物治疗;比较各组治疗前及治疗后1h和1、7、14d患者美国国立卫生研究院卒中量表（National Institute of Health Strike Scale,NIHSS）评分及90d改良Rankin量表（modified Rankin scale,MRS）评分,记录并发症发生情况。结果与治疗前比较,溶栓组治疗后1hNIHSS评分即降低（P〈0.05）,14d时降低更明显（P〈0.01）,对照组仅在治疗后7、14d有所降低（P〈0.05）;溶栓A、B组治疗后1h及1、7、14dNIHSS评分均低于对照组（P〈0.05）;90dMRS评分溶栓组（A组为1.5±0.3,B组为1.7±0.2）明显低于对照组（2.5±0.5）（P〈0.05）,溶栓A、B组间比较差异无统计学意义（P〉0.05）;治疗中溶栓A组并发脑出血率（2.7%）与对照组（2.1%）比较差异无统计学意义（P〉0.05）。结论阿替普酶超时间窗（4.5~7.0h）溶栓治疗急性脑梗死安全、有效。

Objective To evaluate the efficiency and safety of thrombolysis with alteplase for acute cerebral infarction in the broadened therapeutic time window.Methods Ninety-nine patients with acute cerebral infarction were divided into thrombolysis group（n=52）and control group（n=47）.According to the different time of thrombolysis,thrombolysis group was redivided into two subgroups,group A receiving thrombolysis in 4.5to 7.0hours after attack and group B receiving thrombolysis in 3to 4.5hours after attack.Both group A and B were treated with alteplase for thrombolysis,and control group was treated with aspirin and drugs for invigorating blood circulation and eliminating stasis.NIHSS scores before,and 1hour,1day,7days and 14 days after treatment,and modified Rankin scale（MRS）scores 90 days after thrombolysis were compared among groups,and the complications were recorded.Results Compared with before treatment,NIHSS decreased one hour after thrombolysis（P〈0.05）and decreased greatly 14 days after thrombolysis（P〈0.01）in thrombolysis group,and decreased 7and 14 days after thrombolysis in control group（P〈0.05）.NIHSS scores were lower in thrombolysis group at all time points than those in control group（P〈0.05）.MRS scores 90 days after thrombolysis were 1.5±0.3and 1.7±0.2in group A and B respectively,significantly lower than that in control group（2.5±0.5）（P〈0.05）,and there was no significant difference between group A and B（P〉0.05）.There was no significant difference in the incidence of cerebral hemorrhage between group A（2.7%）and control group（2.1%）（P〉0.05）.Conclusions Thrombolysis with alteplase in the broadened therapeutic time window（4.5to 7.0hours）is safe and effective for acute cerebral infarction.