合并心房颤动的急性缺血性脑卒中患者应用rt-PA静脉溶栓的疗效观察及预后影响因素分析

Observation on Curative Effect of rt-PA Ascending Intravenous Thrombolysis of Patients with Acute Cerebral Infarction and Auricular Fibrillation and Analysis of Prognosis Influence Factors

目的探讨应用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗伴有心房颤动急性缺血性脑卒中患者的效果、安全性及影响预后的因素。方法选取2011年8月—2014年11月该院收治发病在4.5 h内的急性缺血性脑卒中患者59例,进行rt-PA静脉溶栓治疗,根据患者既往史及入院时心电图结果将患者分为心房颤动组(16例)和无心房颤动组(43例),溶栓前采用NIHSS评估短期预后,溶栓后90 d行改良Rankin量表(m RS)评分和生活质量指数Barthel Index指数(BI)标准评定。结果(1)溶栓前心房颤动与无心房颤动组NIHSS评分差异无统计学意义(P>0.05);(2)溶栓后90 d心房颤动组患者中溶栓有效率(43.75%)低于无心房颤动组患者溶栓后90 d溶栓有效率(55.81%);(3)心房颤动组的颅内出血比例(31.25%)明显高于无心房颤动组(16.28%)。结论急性缺血性脑卒中合并房颤在无溶栓禁忌症时行rt-PA静脉溶栓治疗是安全、有效的,但疗效较无合并房颤患者差。同时,心房颤动患者行静脉溶栓后的颅内出血风险也高于无心房颤动患者。

Objective To discuss the effect, safety and influence factors of prognosis of rtPA ascending intravenous thrombolysis in treatment of patients with acute cerebral infarction and auricular fibrillation. Methods 59 cases of patients with h acute cerebral infarction and auricular fibrillation within 4.5h in our hospital from August 2011 to November 2014 were selected for the rtPA urokinase treatment, and the patients were divided into the auricular fibrillation group with 16 cases and no auricular fibrillation group with 43 cases according to the past history and electrocardiogram results at admission, and the shortterm prognosis was evaluated by the NIHSS before the thrombolysis, and the prognosis was evaluated by the modified Rankin scale and BI within 90 d after thrombolysis. Results The difference in the NIHSS score between the auricular fibrillation group and no auricular fibrillation group before thrombolysis had no statistical significance （P〉0.05）. The thromboiysis effective rate within 90 d after thrombolysis in the auricular fibrillation group was lower than that in the no auricular fibrillation group （43.75% vs 55.81%）. The intracranial hemorrhage ratio in the auricular fibrillation group was obviously higher than that in the no auricular fibrillation group （31.25% vs 16.28%）. Conclusion The rtPA ascending intravenous thrombolysis in treatment of patients with acute cerebral infarction and auricular fibrillation is safe and effective, but the curative effect is worse than that of patients without fibrillation, at the same time, the intracranial hemorrhage risk after ascending intravenous thrombolysis of patients with auricular fibrillation is higher than that of patients without the auricular fibriUation.