重组组织型纤溶酶原激活剂静脉溶栓治疗觉醒型卒中患者的安全性和有效性

Efficacy and safety of rt-PA intravenous thrombolysis treatment in patients with wake-up strokes

目的:探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗觉醒型脑卒中的安全性和有效性。方法:选取天津市环湖医院神经内科2015年6月至2016年6月住院的缺血性脑卒中患者,根据发病时间是否明确以及是否接受rt-PA静脉溶栓治疗分为觉醒型卒中rt-PA静脉溶栓组(觉醒溶栓组),觉醒型卒中未接受rt-PA静脉溶栓组(觉醒非溶栓组)和发病时间明确rt-PA静脉溶栓组(明确发病组),患者入院后完善相关化验检查,对符合临床入选标准的患者给予rt-PA静脉溶栓治疗。评估各组患者治疗后24 h美国国立卫生研究院卒中量表评分(NIHSS)、颅内出血发生率、90 d改良Rankin评分(mRS)和病死率。结果:各组患者在性别、年龄、入院时NIHSS评分及发病危险因素方面差异均无统计学意义(P>0.05)。觉醒溶栓组与觉醒非溶栓组的患者相比,觉醒溶栓组患者治疗后24 h NIHSS评分改善较明显,获得更好的极好预后及良好预后(P<0.05),而两组颅内出血发生率、病死率差异无统计学意义(P>0.05)。觉醒溶栓组与明确发病组相比较,治疗后24 h NIHSS评分、溶栓治疗后颅内出血发生率、90 d mRS评分以及死亡率均无明显差异(P>0.05)。结论 :觉醒型卒中在头核磁(MRI)弥散加权成像-液体衰减反转恢复序列筛选下的rt-PA静脉溶栓治疗是安全、有效的,可以改善患者的预后。

Objective To investigate the efficacy and safety of rt-PA intravenous thrombolysis treatment in patients with wake-up strokes （WUS）. Methods The patients with ischemic stroke admitted in our hospital from June 2015 to June 2016 were divided into wake-up strokes treated with thrombolysis group （group A）; wake-up strokes without thrombolysis group （group B）; and cXear-onset time treated with thrombolysis group （group C）. Patients in accordance with the clinical inclusion criteria were given rt-PA intravenous thrombolysis treatment. Safety and clinical outcome measures were 24h NIHSS score, 90d modified Rankin score （mRS）, in- tracerebral hemorrhage, and mortality. Results There was no significant difference in the basic data among 3 groups （P 〉 0.05）. In group A, there were higher rates of excellence （14.1% vs 6.9%; P = 0.043） and favor- able outcome （29.7% vs 13.8%; P = 0.023）, but lower 24 h NIHSS score when compared with those of group B, but no significant difference in terms of mortality and intracerebral hemorrhage was found in both groups （P 〉 0.05）. A second comparison between group A and group C showed no significant differences in terms of safety and clinical outcomes. Conclusion Intravenous rt-PA thrombolytic therapy under the guidance of the DWI- FLAIR is effective and safe for WUS patients.