重组人组织纤溶酶原激活物联合尿激酶治疗急性脑梗死的效果分析

The effect of recombinant tissue plasminogen combined with urokinaseon in treatment of acute cerebral infarction

目的：探讨重组人组织纤溶酶原激活物（rtPA）联合尿激酶静脉溶栓治疗发病6 h内的急性脑梗死的有效性及安全性。方法回顾性收集本院2005年11月～2012年12月所有接受静脉溶栓治疗的患者，共纳入129例患者，根据用药史分为rtPA组（63例）及rtPA联合尿激酶组（66例），记录患者的一般临床资料及发病到用药时间；基线及用药7、30、90 d的美国国立卫生院卒中评分（NIHSS）、Barthel指数（BI）；溶栓后的出血率及死亡率。结果两组患者静脉溶栓后各随访时间点NIHSS及BI均较治疗前改善，差异有统计学意义（P〈0.05）；随访90 d，rtPA组与rtPA加尿激酶组相比，NIHSS改善略明显，但两组间差异无统计学意义（P〉0.05）。两组间在安全性和有效性上差异无统计学意义（P〉0.05）。结论发病6 h内无禁忌证的急性脑梗死患者rtPA联合尿激酶静脉溶栓的疗效和安全性与rtPA静脉溶栓无显著性差异。

Objective To investigate the effect and safety of recombinant tissue plasminogen （rtPA） combined with urokinaseon in treatment of acute cerebral infarction. Methods 129 patients who received thrombolytic therapy in our hospital from November 2005 to December 2012 were selected,and were divided into rtPA group （63 cases） and rtPA combined with urokinaseon group （66 cases）.The demographic data,onset-to-needle time and baseline clinical charac-teristics （symptoms,medical history,blood pressure,blood glucose,blood lipids,National Institutes of Health Stroke Scale （NIHSS） score,Barthel index （BI） were recorded at baseline.The NIHSS and BI were recorded at 7 days,30 days and 90 days after thrombolysis.The mortality rate and theincidences of intracerebral and other hemorrhages were recorded. Re-sults After intravenous thrombolysis each follow-up time point,NIHSS and BI of two groups was improved than that be-fore treatment,the difference was significant （P〈0.05）;Follow-up for 90 days,the improvement of NIHSS in rtPA group was better than that of rtPA combined with urokinase group,but there was no significant difference （P〉0.05）.There was no significant difference on the safety and efficacy between the two groups （P〉0.05）. Conclusion For patients with acute cerebral infarction and no contraindications onset within 6 hours,the efficacy and safety of rtPA combined with uroki-nase is similar to urokinase thrombolytic.