阿替普酶与尿激酶静脉溶栓治疗急性脑梗死颅内出血转化及疗效分析

Transformation of Intracerebral Hemorrhage and Effect of Treating Acute Cerebral Infarction by Intravenous Thrombolysis with Alteplase and Urokinase

目的观察阿替普酶与尿激酶静脉溶栓治疗急性脑梗死的颅内出血转化及疗效。方法按纳入的排除标准，回顾性分析2012年-2015年确诊的急性脑梗死患者120例，根据治疗方法不同分为阿替普酶静脉溶栓治疗组（A组）40例，尿激酶静脉溶栓治疗组（B组）40例，非静脉溶栓的对照组（C组）40例，比较3组间治疗后颅内出血转化，对比治疗前、治疗后2h、1d、7d的NIHSS评分，以评估治疗效果。结果三组间颅内出血转化率差异无统计学意义（P〉0．05），提示颅内出血风险均较小；三组NIHSS评分比较，溶栓前差异无统计学意义（P〉O．05），具有可比性；静脉溶栓后的1d和7d，A组和B组分别低于C组，差异有统计学意义（P〈0．05），提示静脉溶栓治疗有效；A组与B组之间比较，差异无统计学意义（P〉O．05），提示两种静脉溶栓疗效差异不大。三组治疗7d后总有效率比较，A组与C组，B组与C组，差异均有统计学意义（P〈0．05）；溶栓治疗的A组与B组比较，差异无统计学意义（P〉0．05）。结论在治疗时间窗内，阿替普酶与尿激酶静脉溶栓治疗急性脑梗死均安全有效。

Objective To observe transformation of intracerebral hemorrhage and effect of treating acute cerebral infarction by intravenous thrombolysis with alteplase and urokinase. Methods 120 patients diagnosed as acute cerebral infarction from 2012 to 2015 were retrospectively analyzed. According to treatment methods, these patients were divided into group A treated by intravenous thrombolysis with alteplase, group B treated by intravenous thrombolysis with urokinase and group C （a control group without intravenous thrombolysis）, with 40 cases in each group. Three groups were compared after treatment based on transformation of intracerebral hemorrhage. A comparison was also made to scores of NIHSS before treatment and 2 h, 1 d and 7 d after treatment, so as to evaluate the therapeutic effects. Results The difference in transformation rate of intracerebral hemorrhage wasn＇t statistically significant among three groups （P 〉 0.05）. It is suggested that the risk of intracranial hemorrhage was small. Before the thrombolysis, there were no statistically significant difference in scores of NIHSS among three groups （P 〉 0.05）. They were comparable. One and seven days after the thrombolysis, the scores of NIHSS were significantly lower in groups A and B than group C, so the differences among these groups were statistically significant （P 〈 0.05）. This indicated that intravenous thrombolysis was effective. By comparing scores of NIHSS between group A and group B, no statistically significant difference were discovered （P 〉 0.05）, the therapeutic effects of two kinds of intravenous thrombolysis were not different. The total effective rate of seven days after the thrombolysis were also compared. The total effective rate were significantly higher in groups A and B than group C （P 〈 0.05）. There was no statistically significant difference between group A and group B （P 〉 0.05）. Conclusion It is safe and effective for treating acute cerebral infarction by intravenous thrombolysis with alteplase and urokinase within the therapeutic time window.