扩大时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的疗效观察

Observation on the efficacy of extended time window rt-PA intravenous thrombolysis in the treatment of vertebral-basilar artery cerebral infarction

目的观察扩大时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的临床疗效。方法对我院收治的85例经多模式MRI证实且行rt-PA静脉溶栓治疗的椎-基底动脉系统脑梗死患者的临床资料进行回顾性分析,根据患者溶栓治疗时间窗不同,将其分为<4.5 h组(42例)和4.5~9.0 h组(43例),比较两组改良Rankin量表(modified Rankin scale,m RS)评分、Barthel指数(Barthel index,BI)评分及神经功能缺损量表(national institutes of health stroke scale,NIHSS)评分,记录两组脑出血发生率。结果两组溶栓后24 h、14 d、30 d及90 d的NIHSS量表评分明显低于溶栓前(P<0.05),但两组治疗前后各时段NIHSS量表评分比较无明显差异(P>0.05);两组溶栓后14 d、30 d及90 d的Barthel指数评分明显高于溶栓前(P<0.05),但两组治疗前后各时段Barthel指数评分比较无明显差异(P>0.05);两组溶栓后90 d的改良Rankin量表评分及预后良好率比较无明显差异(P>0.05);<4.5 h组和4.5~9.0 h组脑出血发生率分别为4.76%和6.78%,两组比较差异无统计学意义(P>0.05)。结论扩大时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的疗效与常规时间窗疗效相当,临床较为安全。

Objective To observe the clinical efficacy of extended time window rt-PA intravenous thrombolysis in the treatment of vertebral-basilar artery cerebral infarction. Methods The clinical data of 85 patients with vertebral-basilar artery cerebral infarction who were admitted to our hospital and were treated by rt-PA intravenous thrombolysis confirmed by multi-mode MRI were retrospectively analyzed. According to the different time windows of patients receiving thrombolysis, they were divided into 4.5 h group（42 cases）and 4.5-9.0 h group（43 cases）. The modified Rankin scale（m RS）score, the Barthel index（BI）score, and the national institutes of health stroke scale（NIHSS） scores were compared between the two groups, and the incidence rate of cerebral bleeding was recorded in both groups. Results The NIHSS scores of the two groups at 24 h, 14 d, 30 d and 90 d after thrombolysis were significantly lower than those be fore thrombolysis（P〈0.05）. However, there was no significant difference in NIHSS scores between the two groups at each time point before and after treatment（P〈0.05）; the Barthel index of the two groups at 14 d, 30 d and 90 d after thrombolysis was significantly higher than that before thrombolysis（P〈0.05）. However, there was no significant difference in Barthel index between the two groups at any time point before and after treatment（P〈0.05）; there was no significant difference in the scores of modified Rankin scale and good prognosis rate between the two groups 90 d after thrombolysis（P〈0.05）; the incidence rates of cerebral hemorrhage in 4.5 h group and 4.5-9.0 h group were 4.76% and 6.78%respectively, and there was no statistically significant difference between the two groups（P〈0.05）. Conclusion The efficacy of extending time window rt-PA intravenous thrombolysis in the treatment of vertebral-basilar artery cerebral infarction is similar to that of conventional time window, and the clinical safety is good.