非瓣膜性心房纤颤脑卒中患者尿激酶静脉溶栓的临床观察

Clinical observation on urokinase thrombolysis for stroke patients with non valvular atrial fibrillation

目的观察非瓣膜性心房纤颤(nonvalvular atrial fibrillation,NVAF)脑卒中患者尿激酶静脉溶栓的临床特点。方法回顾性分析40例行尿激酶静脉溶栓的非瓣膜性心房纤颤脑卒中患者的临床资料,根据美国国立卫生院卒中量表(NIHSS)评分标准分为有效组和无效组,比较两组患者的临床特点及影像学特征。结果溶栓有效组8例,无效组32例,有效率为20.0%,出血转化率为22.5%(9/40)。两组相比,溶栓后NIHSS评分及大脑中动脉闭塞/狭窄比较差异有统计学意义(P<0.01或0.05);但溶栓后出血转化情况差异无统计学意义(P>0.05)。结论非瓣膜性心房纤颤脑卒中患者常伴有颅内大血管严重闭塞或狭窄,溶栓血管再通率低,但与不溶栓的房颤患者相比,溶栓仍可获益。

Objective To investigate the clinical characteristics of urokinase thrombolysis for stroke patients with non valvular atrial fibrillation（NVAF）. Methods The clinical data of stroke patients with non-valvular atrial fibrillation undergoing urokinase thrombolysis were retrospectively analyzed. The patients were divided into Effective Group and Ineffective Group according to national institute of health stroke scale（NIHSS） score. The clinical and imaging characteristics of the two groups were compared. Results There were 8 cases with effective thrombolysis and 32 cases with ineffective thrombolysis, and the effective rate was 20.0%, and hemorrhagic transformation rate was 22.5%. For the comparison between two groups, there was statistical difference in terms of NIHSS score after thrombolysis and middle cerebral artery occlusion and stenosis（P〈0.01 or 0.05）; However, there was no statistical difference in terms of hemorrhagic transformation after thrombolysis（P〉0.05）. Conclusion The stroke patients with NVAF are often accompanied by severe intracranial vascular occlusion or stenosis and had low thrombolytic recanalization. However, they can benefit from thrombolytic therapy compared with those failing to undergo thrombolysis.