月经期的急性缺血性卒中患者应用阿替普酶静脉溶栓治疗的安全性研究

Safety of intravenous thrombolytic therapy for patients with acute ischemic stroke during menstruation

目的 了解月经期的急性缺血性卒中患者应用阿替普酶静脉溶栓的安全性和可行性。方法 选取2013年1月-2015年12月在天津市环湖医院神经内科应用阿替普酶进行静脉溶栓治疗的急性缺血性卒中患者3100例,其中女性在月经期进行静脉溶栓的患者6例,回顾性分析6例在月经期内的急性缺血性卒中患者应用阿替普酶静脉溶栓前后凝血酶原时间（PT）、凝血酶时间（TT）、部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、血红蛋白含量（Hb）的变化,比较其差异,用卫生巾的用量来估算并记录患者月经量,记录静脉溶栓后7 d内症状性颅内出血的发生率。结果 静脉溶栓后患者凝血酶时间延长,纤维蛋白原下降,前后比较差异有统计学意义;溶栓后凝血酶原时间延长,部分活化的凝血酶时间缩短,血红蛋白增高,前后比较差异均无统计学意义。上个月患者的月经血量为（50±10.49）ml,溶栓后6位患者的月经量为（65±4.47）ml,溶栓后出现月经量增加,但均未出现月经量过多。溶栓后7 d内6例患者均未出现症状性颅内出血。结论 月经期的急性缺血性卒中患者应用阿替普酶静脉溶栓可引起月经量增加,但不引起月经量过多,不增加患者7 d内的症状性颅内出血几率,其安全性得到证实。

Objective To understand the safety and feasibility of intravenous thrombolytic therapy in patients with a -cute ischemic stroke during the menstrual period .Methods From January 2013 to December 2015 in the Department of Neurology Tianjin Huanhu Hospital alteplase for 3100 patients with acute ischemic stroke patients with intravenous thrombo-lytic therapy,6 cases in which the female intravenous thrombolysis in the menstrual period ,a retrospective analysis of 6 ca-ses of patients in the menstrual period of acute ischemic stroke after intravenous thrombolysis for general enzyme （ prothrom-bintime PT）,thrombin time （TT）,activated partial thromboplastin time （APTT）,fibrinogen （FIB）,hemoglobin （Hb） changes,compared with the amount of sanitary napkins to estimate and record the patients menstruation within 7 days,recor-ded the incidence of symptomatic intracranial hemorrhage after intravenous thrombolysis .Results Intravenous thrombolysis in patients after prolonged thrombin time ,fibrinogen decreased ,before and after the differences have statistical significance;thrombolysis after prolonged prothrombin time ,activated partial thrombin time is shortened ,increased hemoglobin ,before and after the difference had no statistical significance .Last month in patients with menstrual blood （ 50 ＋10 .49 ） ml, after thrombolytic therapy in six patients of menstrual quantity is （65 ＋4.47） ml,after thrombolysis appear menstrual quantity increased,but there were no excessive menstruation .No symptomatic intracranial hemorrhage occurred within 7 days after thrombolysis in 6 patients.Conclusion Application of acute ischemic stroke patients menstrual period for general enzyme thrombolytic can cause menstruation to measure to increase ,but do not cause excessive menstrual flow ,not to increase the patients within 7 days of symptomatic intracranial bleeding risk ,its safety is confirmed .