阿替普酶治疗脑梗死临床疗效及安全性

Clinical efficacy and safety of alteplase in treatment of cerebral infarction

目的观察阿替普酶治疗3.0~4.5 h的脑梗死临床疗效及安全性。方法选取医院神经内科2011年1月-2017年12月收治的发病3.0~4.5 h的脑梗死患者78例,分成治疗组43例和对照组35例。在对照组常规治疗基础上,治疗组依照rt-PA 0.90 mg/kg计算剂量,先行外周静脉团注总剂量的10%,1 min后将rt-PA总剂量的90%经微量泵持续静脉滴注1 h。将2组患者治疗前、治疗后的6 h、24 h、7 d美国国立卫生研究院卒中量表(NIHSS)评分进行比较。比较2组患者治疗后痊愈率及总有效率,比较2组患者90 d颅内出血的发生率、病死率。结果 2组患者治疗前NIHSS评分比较差异无统计学意义(P>0.05)。治疗组患者治疗后的6 h、24 h、7 d NIHSS评分均明显低于对照组,差异均有统计学意义(P<0.01)。治疗组治疗后痊愈率和总有效率均明显高于对照组,差异有统计学意义(P<0.05)。2组患者90 d颅内出血发生率比较差异无统计学意义(P>0.05)。2组2 d病死率比较差异无统计学意义(P>0.05)。结论阿替普酶治疗3.0~4.5 h的脑梗死,能显著改善患者神经功能缺损症状,安全可靠。

Objective To evaluate the clinical efficacy and safety of alteplase for 3 to 4. 5 hours after acute ischemic stroke. Methods 78 patients diagnosed with 3 to 4. 5 hours after acute ischemic stroke in the hospital from Jan 2011 to Aug2015 were devided into treatment group 43 cases and control group 35 cases. Patients in treatment group received rt-PA at 0. 9 mg/kg dosage,10% of total dose was iv injected and the remaining was iv dripped within the following 60 min. The patients in control group were administered with the basis of conventional therapy. The scores of the national institutes of health stroke scale（ NIHSS） before and after the treatment at 6 h,24 h and 7 d were compared. The cure rate and total effective rate of two groups of patients after treatment were compared. The scores of intracranial hemorrhages and cause of death after the treatment at 90 d were compared. Results There was no significant difference in the NIHSS scores before treatment between two groups（ P〉0. 05）. The NIHSS scores at 6 h,24 h and 7 d after treatment in treatment group were significantly lower than those in control group,and the differences were statistically significant（ P〈0. 01）. The cure rate and total effective rate of treatment group were significantly higher than control group,the difference was statistically significant（ P〈0. 05）. There was no significant difference in the incidence of intracranial hemorrhage between two groups at 90 days（ P〉0. 05）. There was no significant difference in the mortality rate between two groups on 2 days（ P〉0. 05）. Conclusion The treatment of patients with 3 to 4. 5 hours after acute ischemic stroke using alteplase could significantly improve the neurological deficits and clinical safety.