伴心房颤动的急性脑梗死患者静脉溶栓的疗效

Effectiveness and safety of intravenous recombinant tissue plasminogen activator thrombolysis therapy for acute ischemic stroke patients with atrial fibrillation

目的观察伴心房颤动的急性脑梗死患者使用重组组织型纤溶酶原激活物（rt-PA）静脉溶栓的疗效。方法连续收集发病时间〈4．5h的94例应用rt-PA静脉溶栓治疗的急性脑梗死患者，将64例无心房颤动患者作为非心房颤动组，30例伴心房颤动患者作为心房颤动组，并收集同一时段30例未行溶栓治疗的伴有心房颤动的急性脑梗死患者作为对照组，比较3组患者治疗前及治疗后7d的美国国立卫生研究院卒中量表（NIHSS）评分，观察颅内出血（ICH）和症状性颅内出血（SICH）的发生率，采用改良Rankin量表（mRS）对3组患者3个月预后进行分析。结果心房颤动组和非心房颤动组溶栓后7d的NIHSS评分较溶栓前显著降低（P〈0．05或P〈0．01）；对照组治疗前后NIHSS评分比较差异无统计学意义（P〉0．05）；心房颤动组的ICH发生率高于非心房颤动组（26．7％vs．9．4％，P〈0．05），而两组之间SICH发生率差异无统计学意义（13．3％cs.6．3％，P〉0．05）；心房颤动组、非心房颤动和对照组3个月预后良好的比例分别为40．0％、45．3％和16．7％，心房颤动组和非心房颤动组的3个月预后良好比例差异无统计学意义（P〉0．05），均明显高于对照组（P〈0．05或P〈0．01）；心房颤动组、非心房颤动组和对照组预后极差的比例分别为20．0％、18．8％和33．3％（P〉0．05）。结论伴有心房颤动的急性脑梗死患者rt—PA静脉溶栓治疗是安全有效的。

Objective To study the effectiveness and safety of intravenous recombinant tissue plasminogen activator （rt-PA） thrombolysis therapy for acute ischemic stroke in patients with atrial fibrillation （AF）. Methods A total of 94 patients treated with intravenous rt-PA thrombolysis within 4. 5 hours after cerebral stroke onset were analyzed and divided into two groups ： a non-AF group （ n = 64 ） and an AF group （ n = 30）. Another 30 acute ischemic stroke patients with AF without thrombolytic therapy were selected as a control group. The prognosis of the three groups was compared. The National Institute of Health Stroke Scale （NIHSS） was used for comparison among the three groups before therapy and 7 days after therapy. The incidences of intracerebral hemorrhage （ICH） and symptomatic ICH （SICH） were recorded. The patients were followed up for 90 days and their clinical outcomes were assessed by using the modified Rankin scale （mRS）. Results There were no significant differences in the NIHSS scores among three groups before treatment （P 〉 O. 05）. The NIHSS scores were significantly lower in the AF and non-AFgroups 7 days after thrombolysis therapy than those before thrombolysis therapy （P 〈 0. 05 and P 〈 0. O1 ） , and no significant difference in the NIHSS scores was found in the control group before and after therapy （P 〉 0. 05）. The incidence of ICH was significantly higher in the AF group than in the non-AF group （26. 7% vs. 9.4%, P 〈 O. 05）. No significant difference in the incidence of SICH was found between the AF and non-AF groups （ 13.3% vs. 6. 3% , P 〉 0. 05 ）. The favorable prognosis rate was higher in the AF and non- AF groups than in control group （40.0% vs. 16.7%, P〈O. 05; 45.3% vs. 16.7%, P〈O. O1）. No significant difference in very unfavorable prognosis rate was found between the AF and non-AF groups （20. 0% vs. 18. 8%, P 〉0. 05）. Conclusions It is effective and safe of rt-PA thrombolysis therapy for acute ischemic stroke patients with AF.