急性缺血性脑卒中超早期阿替普酶静脉溶栓155例临床研究

Clinical Study on Ultra Early Intravenous Thrombolysis with Alteplase for Treating Acute Ischemic Stroke in 155 Cases

目的观察急性缺血性脑卒中发病4.5 h内重组组织型纤溶酶原激活剂(阿替普酶)静脉溶栓的疗效和安全性,分析影响预后的相关因素。方法选取2014年7月至2016年8月来医院就诊的发病4.5 h内的急性缺血性脑卒中患者234例,分为溶栓组和对照组。其中溶栓组155例静脉予阿替普酶溶栓,对照组79例不进行溶栓治疗。比较两组治疗后的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin(mRS)评分,以及脑出血转化和死亡率。结果溶栓组与对照组在治疗后90 d mRS评分差异有统计学意义(P<0.05);两组脑出血、死亡率比较,差异无统计学意义(P>0.05);溶栓治疗后90 d mRS评分的多因素Logistic回归分析结果显示,溶栓是保护因素,服用抗凝药、入院时mRS评分高和入院时NIHSS评分高是预后差的危险因素。结论急性缺血性脑卒中4.5 h内阿替普酶静脉溶栓能降低残疾率,不增加脑出血和死亡风险。服用抗凝药、入院时mRS评分高和入院时NIHSS评分高是预后差的危险因素。

Objective To observe the clinical efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogn activator（ alteplase） for treating patients with acute ischemic stroke within 4. 5 h, and analyze the factors influencing the prognosis. Methods Totally 234 patients with acute ischemic stroke within 4. 5 h from July 2014 and August 2016 admitted to the hospital were selected,and divided into the thrombolysis group（ n = 155） and the control group（ n = 79）. The thrombolysis group was given intravenous thrombolysis with alteplase, while the control group was not treated with thrombolytic therapy. The NIHSS and mRS scores, cerebral hemorrhage conversion and mortality were compared between the two groups after treatment. Results 90 d after treatment, the difference of mRS score between thrombolytic group and control group was statistically significant（ P〈0. 05）. There was no significant difference in incidence rate of cerebral hemorrhage and mortality between the two groups（ P〉0. 05）. 90 d after thrombolytic therapy,the results of multivariate Logistic regression analysis of mRS score showed that thrombolysis was a protective factor, but taking anticoagulant drugs,high mRS score and high NIHSS score at admission were the risk factors for poor prognosis. Conclusion Intravenous thrombolysis with alteplase for treating patients with acute ischemic stroke within 4. 5 h can reduce disability rate and does not increase the risk of cerebral hemorrhage and death. Taking anticoagulant drugs, high mRS score and high NIHSS score at admission are risk factors for poor prognosis.