重组组织纤溶酶原激活剂静脉溶栓治疗80岁以上老年患者急性缺血性中风的安全性及有效性分析

Safety and efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator in the treatment of patients with acute ischemic stroke aged over 80 years

目的研究重组组织纤溶酶原激活剂(rt-PA)静脉溶栓(IVT)治疗急性缺血性中风的安全性及有效性。方法选取2013年4月至2015年12月于我院收治的急性缺血性脑卒中患者188例为研究对象。根据是否接受IVT治疗,将年龄≥80岁接受rt-PA(0.9 mg/kg)静脉溶栓患者定义为老年IVT组,将年龄≥80岁未接受静脉溶栓患者定义为老年非IVT组;根据年龄大小将接受静脉溶栓患者分为老年IVT组(≥80岁)及年轻IVT组(<80岁)。记录患者的颅内出血情况及治疗后24 h、3个月、6个月的显效率及7 d病死率。结果治疗后1、90、180 d,老年IVT组患者的显效率均高于老年非IVT组(P<0.05)。老年IVT组患者的7 d病死率略低于老年非IVT组,但差异无统计学意义(P>0.05)。老年IVT组、年轻IVT组的颅内出血发生率及显效率比较差异无统计学意义(P>0.05),且均无死亡病例。结论重组组织纤溶酶原激活剂静脉溶栓能够有效治疗80岁以上老年患者急性缺血性中风,且不增加患者的颅内出血发生率及病死率。

Objective To investigate the safety and efficacy of intravenous thrombolysis（IVT） with recombinant tissue plasminogen activator（rt-PA） in the treatment of acute ischemic stroke.Methods Totally 188 patients with acute ischemic stroke treated in our hospital were chosen in this study.According to whether to receive IVT or not patients aged over 80 years were divided into elderly IVT group（receiving rt-PA 0.9 mg/kg） and elderly non-[VT group;according to the age,patients who received IVT were divided into elderly IVT group（≥80 years old） and young IVT group（ 〈80 years old）.The incidence of intracranial hemorrhage,effective rate at 24 h,3 months and 6months after operation and 7-day mortality were recorded.Results The effective rate of elderly IVT group was higher than that of elderly non-IVT group at 24 h,3 months and 6 months after operation（P 〈0.05）.The 7-day mortality in elderly IVT group was slightly lower than that of elderly non-IVT group without significant difference（P 〉0.05）.There was no significant difference in the incidence of intracranial hemorrhage and effective rate between elderly IVT group and young IVT group（P 〉0.05）,and no patient died in the two groups.Conclusion Intravenous thrombolysis with rt-PA can effectively treat the elderly patients（aged over 80 years） with acute ischemic stroke,without increasing the incidence of intracranial hemorrhage and mortality.