不同剂量rt-PA静脉溶栓治疗急性前循环脑梗死伴心房颤动患者的疗效及安全性分析

Efficacy and safety of intravenous thrombolysis with different doses of rt-PA in the treatment of acute anterior circulation cerebral infarction with atrial fibrillation

目的探讨不同剂量rt-PA静脉溶栓治疗急性前循环脑梗死伴心房颤动患者的疗效和安全性。方法回顾性分析2009年10月-2014年10月厦门大学附属第一医院收治的发病4.5小时内进行静脉溶栓的前循环脑梗死伴心房颤动患者61例,按rt-PA使用量分2组,足量组19例,使用0.9 mg/kg rt-PA静脉溶栓治疗;低剂量组42例,使用0.6 mg/kg rt-PA静脉溶栓治疗。分别于溶栓前、溶栓后1、7、30 d不同时间行国立卫生研究院卒中量表（NIHSS）评分;观察比较溶栓前、溶栓后1、7 d凝血功能指标;观察溶栓前、溶栓后1、7、14 d头颅CT;比较溶栓后90 d改良Rankin（MRS）评分。结果 2组溶栓后1、7、30 d NIHSS评分显著降低（P〈0.05）,2组溶栓后各时间点NIHSS评分比较无统计学意义;足量组溶栓后1、7 d血浆凝血酶原时间（prothrombin time,PT）明显增加,纤维蛋白原（fibrinogen,Fib）明显降低,与低剂量组比较,差异显著（P〈0.05）;2组临床转归、死亡率比较差异无统计学意义;低剂量组皮肤黏膜出血率低于足量组（P〈0.05）。结论低剂量组rt-PA静脉溶栓治疗伴心房颤动的前循环梗死安全性更高,可以降低出血风险,减少神经功能缺损,提高患者的生存质量。

Objective To explore the Efficacy and safety of intravenous thrombolysis with different doses of rt-PA in the treatment of acute anterior circulation cerebral infarction with atrial fibrillation. Methods Retrospective analysis of 61 cases of patients with anterior circulation of cerebral infarction with atrial fibrillation from October 2009 to October 2014 in the First Affiliated Hospital of Xiamen University,the incidence within 4. 5 hours of intravenous thrombolysis,and divided into two groups by rt-PA usage,19 cases in adequate group,received 0. 9 mg/kg rt-PA intravenous thrombolytic therapy,42 cases in low dose group,received 0. 6 mg/kg rt-PA intravenous thrombolysis. Before and after thrombolysis 1,7 and 30 days,NIHSS score was measured,the indexes of coagulation were observed at before thrombolysis and 1,7 days after thrombolysis,,CT scans were performed at 1,7,and14 days after thrombolysis,and Rankin（ MRS） scores were compared at 90 days after thrombolysis. Results NIHSS 1,7,30 days scores of 2 groups were significantly decreased after thrombolysis（ P〈0. 05）,there was no statistically significant at at each time point after thrombolysis. Plasma prothrombin time increased significantly at 1 day and 7 days after thrombolysis,fibrinogen was significantly lower,compared with the low dose group,the difference was significant（ P〈0. 05）. There was no significant difference between the two groups in clinical outcome and mortality. The rate of mucosal bleeding in low dose group was lower than that in adequate group（ P〈0. 05）. Conclusion Low-dose rt-PA group intravenous thrombolysis with anterior circulation of atrial fibrillation is more safe,can reduce the risk of bleeding,reduce neurological deficits and improve the quality of life of patients.