不同剂量阿替普酶溶栓治疗急性脑梗死效果评价

Effects of Different Doses of Alteplase Thrombolysis in Treatment of Acute Cerebral Infarction

目的比较不同剂量阿替普酶治疗急性脑梗死的效果。方法选择2012年11月—2014年5月入住北京军区总医院263临床部神经内科的符合溶栓指征的急性脑梗死(起病在4.5 h内)患者46例,随机分为两组,低剂量组(n=23)予0.6 mg/kg的阿替普酶、标准剂量组(n=23)予0.9 mg/kg的阿替普酶静脉溶栓治疗。比较两组治疗前及治疗后1、3天美国国立卫生研究院卒中患者神经功能缺损评分量表(national institutes of health stroke,NIHSS)及格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分;比较静脉溶栓治疗前及治疗后7、28、90天改良Rankin(MRS)评分;比较两组治疗后总有效率。结果与治疗前比较,两组治疗后1、3天GCS评分均显著增高(P<0.05),NIHSS评分显著降低(P<0.05),治疗后28、90天MRS评分显著降低(P<0.05);治疗后同时间两组上述指标差异均无统计学意义(P>0.05);两组疗效差异无统计学意义(P>0.05)。结论不同剂量阿替普酶静脉溶栓治疗急性脑梗死均可促进神经功能缺损早期恢复、改善预后、提高患者的生活质量,低剂量阿替普酶静脉溶栓疗效肯定,值得临床推广应用。

Objective To compare the effects of different doses of Alteplase in treatment of acute cerebral infarction. Methods A total of 46 acute cerebral infarction patients,who were consistent with thrombolysis indications（ onset within 4. 5 h）,were randomly divided into low dose group（ n = 23） and standard dose group（ n = 23） during November2012 and May 2014. The low dose group received 0. 6 mg / kg Alteplase,while standard dose group was treated with 0. 9mg / kg Alteplase through intravenous thrombolysis. Scores of national institutes of health stroke（ NIHSS） and Glasgow coma scale（ GCS） were compared in the two groups before and on 1stand 3rdd after treatment; the modified Rankin scale（ MRS） scores were compared before and on 7th,28 thand 90thd after treatment; the total efficiency of the two groups was also compared before and after treatment. Results Compared with those before treatment,in the two groups GCS scores were significantly increased（ P〈0. 05）,while NIHSS scores were significantly decreased on 1stand 3rdd after treatment（ P〈0. 05）,and the MRS scores were significantly decreased on 28 thand 90thd after treatment（ P〈0. 05）; the differences in the indexes at the same time after treatment between the two groups were not statistically significant（ P 〉0. 05）;the difference in curative effect between the two groups was not statistically significant（ P 〉0. 05）. Conclusion Different doses of Alteplase thrombolysis in treatment of acute cerebral infarction can help early recovery of neurologic impairment,improve prognosis and the quality of life of patients,and the low dose Alteplase by intravenous thrombolysis has good curative effect.