急性期无效的静脉溶栓脑梗死患者随访研究

Follow-up studies of patients with acute cerebral infarction with no significant improvement of symptoms 24 hours after intravenous thrombolysis

目的评价在溶栓后24 h症状无明显改善的急性脑梗死患者后期能否从阿替普酶静脉溶栓中获益。方法回顾性分析海南省人民医院神经内科2012年6月至2016年10月采用阿替普酶静脉溶栓治疗的57例急性脑梗死患者的临床资料,其中14例符合24 h内有效的标准,将其余43例症状无明显改善者纳入观察组,并选择发病12 h内入院非溶栓的43例急性脑梗死患者作为对照组。在病程90 d后观察美国国立卫生研究院卒中量表(NIHSS)评分情况、改良Rankin量表评价无残障(0~2级)受试者百分比、Barthel指数≥75分的受试者百分比。结果在病程第90 d,观察组和对照组患者的NIHSS评分分别为(3.83±2.31)分、(4.79±1.94)分,观察组低于对照组,差异有统计学意义(P<0.05);观察组和对照组无明显残障患者分别为88.01%、69.77%,Barthel指数≥75的患者分别为83.33%、65.12%,组间比较,观察组均高于对照组,差异均有统计学意义(P<0.05)。结论应用阿替普酶静脉溶栓后24 h未见明显改善的急性脑梗死患者,90 d后较未溶栓的患者有更好的预后。

Objective To observe whether patients with acute cerebral infarction who had not significant im-provement of symptoms 24 hours after intravenous thrombolysis with alteplase can benefit from the thrombolysis later. Methods We retrospectively analyzed the clinical data of 57 patients with acute cerebral infarction treated with intrave-nous thrombolysis from June 2012 to October 2016 in Hainan General Hospital, 14 of which met the effective criteria within 24 hours. The remaining 43 patients who showed no significant improvement were included in the study group, and 43 patients with acute cerebral infarction who had no thrombolysis within 12 hours after onset were selected as the control group. The National Institutes of Health Stroke Scale （NIHSS） score, the modified Rankin scale and Barthel in-dex≥75 were observed 90 days after the course of the disease. Results After 90 days, the NIHSS scores were （3.83 ± 2.31） in the study group and （4.79±1.94） in the control group, with statistically significant difference （P〈0.05）. The pro-portion of patients with no obvious disability （modified Rankin Scale 0-2） and that of Barthel index≥75 were 88.01%, 83.33% in the study group, versus 69.77% and 65.12% in the control group （P〈0.05）. Conclusion For patients with acute cerebral infarction who did not have a significant improvement in 24 hours after intravenous thrombolysis with al-teplase, they had better prognosis than those without thrombolysis after 90 days.