CT指导超时间窗脑梗死患者阿替普酶静脉溶栓疗效观察

Efficacy observation of thrombolytic therapy with Alteplase for patients with acute extending thrombolytic time window cerebral infarction guided by CT

目的探讨CT指导超时间窗脑梗死患者阿替普酶静脉溶栓的临床疗效。方法选取2015年10月～2018年3月我院急诊科收治的56例发病时间在6 h内的给予静脉溶栓的急性脑梗死患者作为研究对象,依据患者发病至开始用药时间的长短分为A、B两组,A组为时间窗内(<4.5 h)溶栓组(30例),B组为超时间窗(4.5～6.0 h)溶栓组(26例),均给予重组人组织纤维蛋白溶酶原激活剂(rt-PA)标准剂量静脉溶栓,B组溶栓前给予多模CT检查,静脉溶栓24 h后两组患者均复查常规头颅CT,并记录两组患者的不同时间节点的NIHSS评分与不良反应。结果 A组患者治疗后的NIHSS评分[(3.8±1.8)分]低于治疗前[(11.6±3.2)分],差异有统计学意义(P<0.05);B组患者治疗后的NIHSS评分[(4.5±2.7)分]低于治疗前[(13.1±2.3)分],差异有统计学意义(P<0.05);A组患者治疗后7 d的NIHSS评分低于B组,差异有统计学意义(P<0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论应用多模式CT指导下静脉超时间窗溶栓能有效增加脑血流灌注,促进神经系统功能缺失的恢复,并且是安全的。

Objective To study the clinical effect of thrombolytic therapy with Aheplase for patients with acute extend- ing thrombolytic time window cerebral infarction guided by CT. Methods From October 2015 to March 2018, 56 pa- tients with acute ischemic stroke and reached hospital within 6 hours and received intravenous thrombolysis treated in Department of Emergency of our hospital were selected as the subjects. They were divided into group A and group B by the onset to treatment time. Group A was rt-PA therapy started 0-4.5 h （30 cases）, group B was rt-PA therapy started 4.5-6.0 h （26 cases）. They all received standard dose intravenous rt-PA thrombolytic therapy, the patient of group B received muhimodal CT. The patients of the two group patients have a normal CT scan in 24 h after intravenous throm- bolysis. The NIHSS score at different time and the adverse effects were recorded. Results The NIHSS scores after intra- venous thrombolysis （[3.8±1.8] points） were lower than that before intravenous thrombolysis （[11.6±3.2] points） in group A, the difference was statistically significant （P〈0.05）. The NIHSS scores after intravenous thrombolysis （[4.5±2.7] points） were lower than that before intravenous thrombolysis （[13.1±2.3] points） in group B, the difference was statisti- cally significant （P〈0.05）. The NIHSS scores afler 7 d treatment in group A was lower than that in group B, the differ- ence was statistically significant （P〈0.05）. There was no statistical significance in the adverse effects incidence between the two groups. Conclusion Intravenous thrombolysis with rt-PA in patients with acute extending thrombolytic time window cerebral infarction guided by CT can significantly improve the blood perfusion, promote the recovery of neuro- logical function, and is safety.