轻型缺血性卒中静脉溶栓患者疗效及安全性分析

Efficacy and safety of intravenous thrombolysis on minor ischemic stroke

目的分析轻型缺血性卒中(MIS)患者在不同溶栓时间窗应用重组组织型纤溶酶原激活物(rtPA)静脉溶栓急性期并发症和90 d预后的差异。方法回顾性收集神经内科住院并接受静脉溶栓治疗NIHSS基线评分≤5分的轻型缺血性卒中患者,共166例。按溶栓时间窗不同分为0~3 h和~4.5 h两组,观察并比较急性期出血转化、溶栓后24 h NIHSS评分变化及90 d的mRS评分。结果0~3 h组患者24 h NIHSS减分≥1分及24 h NIHSS恢复至0分的比例明显高于~4.5 h组患者(67.1%vs 49.0%,P=0.020;27.1%vs 13.5%,P=0.028)。90 d良好预后(mRS评分0~1分)的比率为85.5%,症状性颅内出血比率为1.2%,logistic回归分析显示导致90 d不良预后的危险因素为:大血管病变(95%CI 0.133~0.860)、溶栓后出血转化(95%CI 0.020~0.556)。结论轻型缺血性卒中患者溶栓治疗短期预后好,症状性颅内出血发生率低,大血管闭塞可能与不良预后有关。

Objective To analyze the 90-day prognosis and complications of minor ischemic stroke(MIS)treated with intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA)at different time windows.Methods A total of 166 patients admitted in the neurological department of the Zengcheng People's Hospital from June 2012 to June 2018.with MIS(baseline NIHSS≤5)were retrospectively analyzed.All patients were assigned into two groups according to the time from onset to treatment,0-3 and 3-4.5 hours.Intracranial hemorrhage,changes of NIHSS 24 hours after thrombolysis and mRS score 90 days after thrombolysis were observed and compared between the two groups.Results Patients with treatment window of 0-3 hours had a significantly higher proportion of NIHSS reduction≥1 or completely recovery to normal than patients with treatment window of 3-4.5 hours(67.1%vs.49.0%,P=0.020;27.1%vs.13.5%,P=0.028).There were 85.5%of patients with good prognosis(mRS score 0-1)on the 90th day.The rate of symptomatic intracranial hemorrhage was 1.2%.The main risk factors for poor prognosis on the 90th day were large-vessel occlusion and symptomatic intracranial hemorrhage.Conclusion The short-term prognosis of thrombolytic therapy in patients with MIS is good,and the incidence of symptomatic intracranial hemorrhage is low.The poor prognosis may be correlated to large-vessel occlusion.