超早期rt-PA静脉溶栓治疗对高龄脑梗死患者的预后分析

Treatment effect and prognostic analysis of ultra-early rt-PA intravenous thrombolysisin patients with elderly cerebral infarction

目的探讨超早期重组组织纤溶酶原激活物(rt-PA)静脉溶栓对高龄脑梗死患者的疗效及预后分析。方法回顾性分析我院2014年1月～2017年8月收治的82例高龄脑梗死患者临床资料,按不同治疗方式分为对照组和研究组,每组各41例。对照组予以超早期尿激酶静脉溶栓治疗,研究组予以超早期rt-PA静脉溶栓治疗,比较两组临床疗效、血液流变学、美国国立卫生研究院卒中量表(NIHSS)、Barthel指数、并发症及预后情况。结果研究组总有效率高于对照组,差异有统计学意义(P<0.05);治疗前,两组血液流变学指标、NIHSS、Barthel指数比较差异均无统计学意义(P>0.05);治疗后,两组血液流变学指标、NIHSS均明显下降,研究组低于对照组(P<0.05),两组Barthel指数均上升,研究组高于对照组(P<0.05);研究组并发症发生率、死亡率均低于对照组,差异有统计学差异(P<0.05)。结论超早期rt-PA静脉溶栓对高龄脑梗死患者的治疗效果肯定,安全性高,有利于神经功能的恢复,建议合理延长时间窗,以扩张静脉溶栓适应证。

Objective To analyze the treatment effect and prognostic analysis of ultra-early recombinant tissue plasminogen activator（rt-PA）intravenous thrombolysisin patients with elderly cerebral infarction.Methods 82 patients with elderly cerebral infarction from January 2014 to August 2017 in our hospital was treated.According to different treatment methods,those patients were divided into control group and the research group,with 41 cases in each group.The control group was treated with ultra-early intravenous urokinase thrombolysis.The research group was treated with ultra-early rt-PA intravenous thrombolysisin.The clinical curative effect,hemorheology,United States national institutes of health stroke scale（NIHSS）scores,Barthel index,complications and prognosis between the two groups were compared.Results Total effective rate in research group（78.05%）was higher than control group（56.10%）（P〈0.05）.Before treatment,hemorheological indexes,NIHSS and Barthel index in two group had no differences（P〉0.05）.After treatment,the blood rheological indexes and NIHSS in the two groups were significantly decreased,and the study group was lower than the control group（P0.05）.The complication rate and mortality rate in research group were lower than control group（P0.05）.Conclusion The ultra-early rt-PA intravenous thrombolysisin is effective for patients with elderly cerebral infarction,can help the recovery of nerve function,high security,recommend a reasonable extension of the time window and expand the indications of intravenous thrombolysis.