年龄对阿替普酶治疗急性脑梗死短期预后的影响

The effect of age on short-time prognosis of acute cerebral infarction treated by alteplase

目的：探讨不同年龄急性脑梗死（ACI）患者接受阿替普酶静脉溶栓对预后的影响。方法选择天津市静海区医院2014年1月至2015年12月收治的98例ACI患者，按年龄分为高龄组（75岁以上）和低龄组（50岁以下）。两组患者均给予阿替普酶（0.9 mg/kg）静脉溶栓治疗，其中10%的剂量静脉推注，其余剂量持续1 h泵入。于溶栓前和溶栓后1 d、21 d采用美国国立卫生研究院卒中量表（NIHSS）评分评价患者神经功能缺损情况，记录出血等不良事件的发生率及病死率。结果与溶栓前比较，低龄组和高龄组溶栓后1 d和21 d NIHSS评分（分）均明显降低（低龄组1d为6±4比10±5，21 d为2±2比10±5，高龄组1d为7±5比10±7，21 d为6±4比10±7，均P＜0.05），且溶栓后21 d低龄组NIHSS评分明显低于高龄组（分：2±2比6±4，P＜0.05）。溶栓后，高龄组轻微皮肤黏膜出血发生率明显高于低龄组，差异有统计学意义〔7.69%（4/52）比2.17%（1/46），P＜0.05〕；高龄组出现症状性脑出血并死亡的患者数较低龄组增多〔1例（1.92%）比0〕。结论不同年龄ACI患者阿替普酶静脉溶栓后均可获益，低龄患者较高龄患者获益程度更高，预后相对更好。

ObjectiveTo explore the effect of patients with acute cerebral infarction （ACI） at different ages receiving intravenous injection of alteplase for thrombolysis on their prognosis.Methods Ninety-eight ACI patients admitted to Jinghai Hospital of Tianjin from January 2014 to December 2015 were conducted in this study, and they were divided into elderly group （over 75 years old） and younger age group （under 50 years old）. The patients in two groups of were given intravenous thrombolytic therapy with alteplase （0.9 mg/kg）, 10% of the dose was intravenously injected, and continuously the remaining dose was pumped into the vein for 1 hour. Before the thrombolysis and 1 day and 21 days after thrombolysis, the score of United States National Institutes of Health Stroke Scale （NIHSS） was used to evaluate neurological deficits, the incidence of bleeding adverse event and mortality were recorded.Results Compared to the before thrombolysis, the NIHSS scores after thrombolysis on the 1st day and 21st day were significantly decreased in the two groups （the younger age group 1 day： 6±4 vs. 10±5, 21 days 2±2 vs. 10±5, the elderly group 1 day： 7±5 vs. 10±7, 21 days： 6±4 vs. 10±7, allP 〈 0.05）, and NIHSS score in the younger age group was significantly lower than that in the elderly group on the 21st day after thrombolysis （2±2 vs. 6±4,P 〈 0.05）. After thrombolysis, the incidence of minor mucocutaneous bleeding in elderly group was obviously higher than that in younger age group, the difference being statistically significant [7.69% （4/52） vs. 2.17% （1/46）,P 〈 0.05]; the elderly group had higher symptomatic intracerebral hemorrhage and death events than those in younger age group [1 （1.92%） vs. 0].Conclusion Different ages of patients with ACI can benefit from intravenous thrombolysis with alteplase, showing the younger the age of the patients, the better the benefit they can get and have relatively better prognosis.