基层医院阿替普酶静脉溶栓治疗急性缺血性脑卒中117例疗效分析

Effect of intravenous thrombolysis with alteplase for 117 acute ischemic stroke patients in grass-root hospitals

目的回顾性分析重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗超急性期缺血性脑卒中近期预后,探讨其在基层综合性医院使用的有效性及安全性。方法采用回顾性分析,选择2012年4月~2014年9月在玉田县医院神经内科住院的急性缺血性脑卒中患者187例,根据治疗不同分为低剂量组60例（rt-PA 0.6mg/kg）,标准剂量组57例（rt-PA 0.9mg/kg）,对照为组70例（未行rt-PA,仅常规治疗）。系统采集所有患者病历资料,均完成28d及90d随访。以改良的Rankin量表（mRS）评分0~1分为预后良好,分析各组有效性和安全性是否存在差异。结果低剂量组、标准剂量组和对照组出院和28d随访时预后良好率比较,差异无统计学意义（30.0%vs 31.6%vs 18.6%,P=0.182;38.3%vs 45.6%vs 27.1%,P=0.092）,低剂量组和标准剂量组90d时预后良好率明显高于对照组（50.0%vs 52.6%vs 32.9%,P=0.047）。低剂量组、标准剂量组和对照组出血发生率比较,差异有统计学意义（5.0%vs 10.5%vs 0%,P〈0.05）;低剂量组与标准剂量组出血发生率差异无统计学意义（P=0.314）。随访90d时,低剂量组、标准剂量组和对照组病死率比较,差异无统计学意义（5.0%vs 3.5%vs 4.3%,P〉0.05）。结论 rt-PA静脉溶栓可改善缺血性脑卒中患者90d预后,降低患者残疾,但有一定出血风险,低剂量rt-PA较标准计量出血少。

Objective To study the efficiency and safety of intravenous thrombplysis with rt-PA alteplase for acute ischemic stroke（AIS）patients in grass-root hospitals by retrospectively analyzing their short-term outcome.Methods One hundred and eighty-seven AIS patients admitted to our hospital were divided into 0.6mg/kg rt-PA group（n=60）,0.9mg/kg rt-PA group（n=57）,and control group（n=70）.The patients were followed up for 28 days and 90 days respectively.Their outcome was considered good when their mRS score was 0-1.Results No significant difference was found in the percentage of good outcome between 3groups at discharge and during the 28 days follow-up period（30.0% vs 31.6% vs 18.6%,P=0.182;38.3% vs 45.6% vs27.1%,P=0.092）.The percentage of good outcome was significantly different between 3groups during the 90 days follow-up（50.0%vs 52.6% vs 32.9%,P=0.047）.The incidence of hemorrhage was significantly higher in 0.6mg/kg rt-PA group and 0.9mg/kg rt-PA group than in control group（5.0%vs 10.5% vs 0%,P〈0.05）.No significant difference was found in mortality rate between 3groups（5.0%vs 3.5%vs 4.3%,P〉0.05）.Conclusions Intravenous thrombolysis with rt-PA can improve the outcome in AIS patients after 90 days and induce the incidence of their inability with a certain risk of hemorrhage.The volume of hemorrhage is smaller after 0.6mg/kg rt-PA treatment than after 0.9mg/kg rt-PA treatment.