阿替普酶急诊溶栓治疗超早期急性脑梗死的疗效观察

Efficacy observation of alteplase in the emergency thrombolytic treatment of ultraearly acute cerebral infarction

目的探讨阿替普酶急诊溶栓治疗超早期急性脑梗死的临床疗效。方法选取接受阿替普酶急诊静脉溶栓治疗的超早期急性脑梗死患者32例,作为观察组。另选取同期接受尿激酶急诊溶栓治疗的超早期急性脑梗死患者30例,作为对照组。比较2组患者溶栓前后的凝血功能指标、美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分、预后及不良反应。结果与治疗前比较,2组溶栓治疗后1,7和14d的NIHSS评分均显著下降(P<0.05),2组患者溶栓治疗前后的NIHSS评分、预后良好率和病死率比较差异均无统计学意义。观察组溶栓前后6h的凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)值对比差异无统计学意义;对照组溶栓6h后的PT、TT、FIB和APTT值均显著高于溶栓前(P<0.05),2组溶栓后6h的PT、TT、FIB和APTT值对比差异均有统计学意义(P<0.05)。观察组的不良反应发生率显著低于对照组(P<0.05)。结论超早期急性脑梗死患者用阿替普酶急诊溶栓治疗,能减轻患者的神经功能损伤、改善患者预后,且出血风险小、安全性好。

Objective To evaluate the clinical efficacy of alteplase in the emergency thrombolytic treatment of ultra-early acute cerebral infarction.Methods 32 cases patients with ultra-early acute cerebral infarction received alteplase intravenously as the observation group,another 30 cases patients received urokinase intravenously as the control group.The coagulation function,National Institute of Health Stroke Scale（NIHSS）,prognosis and adverse reactions before and after thrombolysis between the 2 groups were recorded and compared.Results Compared with before treatment,NIHSS scores of the 2 groups at 1,7 and 14 dafter thrombolytic therapy were significantly decreased（P0.05）,and there was no significant difference in the NIHSS scores between the 2 groups before and after thrombolytic therapy.There was no significant difference in the prognosis rate and mortality rate between the 2 groups.There was no significant difference of prothrombin time（PT）,thrombin time（TT）,fibrinogen（FIB）and activated partial thromboplastin time（APTT）before and 6 hafter thrombolysis in the observation group.The values of PT,TT,FIB and APTT in the control group were significantly higher than those before thrombolysis（P0.05）.There were significant differences in PT,TT,FIB and APTT between the 2 groups after thrombolysis（P0.05）.The incidence of adverse reactions in the observation group was significantly lower than that in the control group（P〈0.05）.Conclusion Alteplase in the emergency thrombolytic treatment of ultra-early acute cerebral infarction can reduce the neurological impairment and improve the prognosis of patients with acute cerebral infarction.The risk of hemorrhage is small and the safety is good.