重组组织型纤溶酶原激活物静脉溶栓治疗超早期脑梗死临床分析

Clinical analysis of intravenous thrombolysis treatment with recombinant tissue plasminogen activator in super early cerebral infarction

目的:探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗超早期脑梗死的临床疗效及预后。方法 :选取我院2009年5月至2014年5月收治的符合入选条件的超早期脑梗死患者336例,行rt-PA静脉溶栓治疗(溶栓组);选取同期非溶栓常规治疗的超早期脑梗死患者306例作为对照组。比较2组患者治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、治疗效果、24 h内及3个月并发症及预后情况。结果:2组患者治疗前的NIHSS差异无统计学意义。治疗后2组患者的NIHSS分值均有下降,2组间比较差异具有统计学意义(P<0.05);溶栓组的总有效率为93.5%,明显高于非溶栓治疗的80.6%(P<0.05);2组患者药物过敏发生率、血管再闭塞率等差异无统计学意义(P>0.05);溶栓治疗组能显著改善患者3个月预后(P<0.05)。24 h内溶栓组脑出血率高于对照组(P<0.05),3个月2组患者脑出血率无显著差异(P>0.05)。24 h内病死率溶栓组高于对照组(P<0.05),3个月病死率溶栓组仍高于对照组(P<0.05)。结论 :rt-PA静脉溶栓治疗安全有效,有利于降低致残率,提高患者的生活质量。对于符合溶栓指征的急性脑梗死患者推荐早期应用rt-PA静脉溶栓治疗。溶栓相关性脑出血使溶栓组患者死亡率增加。

Objective To investigate the clinical efficacy and prognosis of intravenous thrombolysis treatment with recombinant tissue plasminogen activator（rt-PA） in super early cerebral infarction. Methods A total of 642 patients with super early cerebral infarction from May 2009 to May 2014 were divided into two groups; thrombolysis group consisted of336 cases and 306 cases without thrombolysis treatment served as control group. Patients in thrombolysis group were given intravenous rt-PA thrombolysis treatment and patients in control group were given standard therapy. Neurological deficit assessed by the National Institute of Health stroke scale（NIHSS） score, treatment efficacy, complications within 24 h and prognosis in 3 months between these two groups were compared. Results There was no statistically significant difference in NIHSS score between the two groups before treatment. The NIHSS score of both the two groups decreased after treatment;the decrease in thrombolysis group was more significant than in control group（P0.05）. The overall effective rate in thrombolysis group was 93.5%, significantly higher than that in control group（80.6%, P0.05）. No statistically significant differences in drug allergic rate and vascular re-occlusion rate were found between the two groups（P0.05）. The 3-month prognosis was better in thrombolysis group than in control group（P0.05）. Intracerebral hemorrhage rate within 24 h was higher in thrombolysis group than in control group（P0.05）. No significant difference was found in intracerebral hemorrhage rate between the two groups in 3 months（P0.05）. Conclusions The intravenous rt-PA thrombolysis treatment is safe and effective. It can improve the prognosis, reduce morbidity, and improve patient ＇s life quality. It is recommended that intravenous rt-PA thrombolysis treatment should be used in the early stage of acute cerebral infarction patients with thrombolysis indication.