rt-PA静脉溶栓治疗高龄急性脑梗死患者的临床观察

Clinical Observation of rt-PA Intravenous Thrombolysis in the Treatment of Elderly Acute Cerebral Infarction

目的:探讨重组人组织型纤维蛋白溶酶原激活物(rt-PA)静脉溶栓治疗高龄(≥75岁)急性脑梗死(ACI)患者的临床疗效和安全性。方法:选择78例高龄ACI患者,在常规治疗基础上,按患者或家属溶栓意愿分为溶栓组40例与非溶栓组38例。非溶栓组患者口服阿司匹林200 mg,qd;溶栓组患者采用rt-PA 0.9 mg/kg(最大剂量为90 mg),先于1 min内静脉推注10%,余量在60min内静脉滴注,溶栓治疗24 h后无禁忌证者使用阿司匹林200 mg,qd。两组疗程均为14 d。比较两组患者的总有效率,治疗前和治疗后24 h、7 d、14 d的美国国立卫生研究院卒中量表(NIHSS)评分,以及治疗后90 d预后情况,并观察两组不良反应发生情况。结果:总有效率溶栓组为67.50%,非溶栓组为52.63%,差异有统计学意义(P<0.05);两组患者治疗后24 h、7 d、14 d的NIHSS评分比较差异有统计学意义(P<0.05);90 d预后情况溶栓组优于非溶栓组,差异有统计学意义(P<0.05);两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:4.5 h时间窗内rt-PA静脉溶栓治疗高龄ACI患者安全、有效,可降低致残率和病死率、改善预后。

OBJECTIVE： To investigate clinical efficacy and safety of recombinant human tissue type plasminogen activator （rt-PA） intravenous thrombolytic in the treatment of elderly patients （over 75 years old） with acute cerebral infarction （ACI）. METHODS： 78 elderly ACI patients, on the basis of routine treatment, were divided into thrombolysis group （40 cases） and non-thrombolysis group （38 cases） according to the will of patients or family members. Non-thrombolysis group received aspirin 200 mg, qd; thrombolysis group was given rt-PA 0.9 mg/kg （maximum dose of 90 rag） by intravenous push of 10% dose within 1 min, and intravenous dripping of residue dose within 60 min; receiving aspirin 200 mg, qd, 24 h after thrombolytic therapy with- out contraindications. Both groups were treated for 14 days. The effective rate, NIHSS score before treatment and 24 h, 7 d and 14 d after treatment, prognosis after 90 d were compared between 2 groups, and the occurrence of ADR was observed in 2 groups. RE- SULTS： The total effective rate was 67.50% in thrombolysis group and 52.63% in non-thrombolysis group, with statistical signifi- cance （P〈0.05） ; there was significant difference in NIHSS score between 2 groups 24 h, 7 d, 14 d after treatment （P〈0.05） ; 90 d prognosis of thrombolysis group was superior to that of non-thrombolysis group, there was statistically significance （P〈0.05） ; there was no statistical significance in the incidence of ADR between 2 groups （P〉0.05）. CONCLUSIONS： 4.5 h time window rt-PA intravenous thrombolytic therapy is safe and effective for elderly patients with ACI, and can reduce disability and fatality, im- prove prognosis.