不同时间窗rt-PA静脉溶栓治疗急性脑梗死患者的疗效和预后情况分析

Analysis of the efficacy and prognosis of patients with acute cerebral infarction treated with rt-PA intravenous thrombolysis at different time windows

目的在不同时间窗使用rt-PA静脉溶栓治疗急性脑梗死患者观察治疗效果和预后情况。方法选取2018年1月至2018年12月于本院进行rt-PA静脉溶栓治疗ACI的患者86例为研究对象,按发病时间分为A组和B组。其中A组43例,发病时间3.0~4.5h,男30例、女13例,平均年龄(65.3±7.8)岁;B组共43例,发病时间<3.0h,男29例、女14例,平均年龄(66.1±6.9)岁。对两组ACI患者均进行rt-PA静脉溶栓治疗,使用NIHSS对患者神经功能缺损情况进行评价,对治疗效果进行判断,随访后对预后进行评价。结果治疗后,使用NIHSS评分后发现,B组ACI患者总有效率(83.72%)明显高于A组(74.42%)ACI患者(c2=5.319,P=0.034)。A组治疗后7d患者NIHSS评分明显低于治疗前(t=5.38,P=0.00)及治疗后24h(t=1.23,P=0.11);B组治疗后7d患者NIHSS评分明显低于治疗前(t=3.68,P=0.00)及治疗后24h(t=0.61,P=0.27)。通过两组ACI患者预后mRS评分发现,所有患者评分为递减趋势,A组治疗后6个月评分与B组比较差异无统计学意义;B组患者治疗后9个月、1年评分明显低于A组评分(t=3.001,P=0.025;t=2.991,P=0.038)。结论发病在3~4.5h内对ACI患者实施rt-PA静脉溶栓治疗具有较好的治疗效果,提高患者的存活率,越早期对ACI患者实施rt-PA静脉溶栓治疗效果越好,越有利于预后。

Objective The therapeutic effect and prognosis of patients with acute cerebral infarction were treated with rt-PA intravenous thrombolysis at different time windows.Methods 86 patients who underwent rt-PA intravenous thrombolysis for ACI in our hospital from January 2018 to December 2018 were enrolled in the study.They were divided into group A and group B according to the onset time.There were 43 cases in group A, the onset time was 3.0-4.5 h,the ratio of male to female was 30∶13,the average age was (65.3±7.8) years old;43 cases in group B,the onset time was <3.0 h,the ratio of male to female was 29∶14,the average age (66.1±6.9) years old.Patients with both ACI were treated with rt-PA intravenous thrombolysis.The NIHSS was used to evaluate the neurological deficit of the patients.The therapeutic effect was judged and the prognosis was evaluated after follow-up.Results After treatment with both groups of ACI patients,the total effective rate (83.72%) was significantly higher in group A patients than in group A (74.42%) ACI patients (c2=5.319,P=0.034).The NIHSS score of patients in group A was significantly lower than that before treatment (t=5.38,P=0.00) and 24 h after treatment (t=1.23,P=0.11).The NIHSS score in group B after 7 days of treatment was significantly lowe than before treatment (t=3.68,P=0.00) and 24 h after treatment (t=0.61,P=0.27).The prognostic mRS scores of the two groups of ACI patients showed that all patients scored a decreasing trend.The scores of the 6 months after treatment in group A were not significantly different from those in group B after treatment.Group B patients were treated 9 months after treatment,the 1-year score was significantly lower than the A group score (t= 3.001,P=0.025;t=2.991,P=0.038).Conclusion The incidence of rt-PA intravenous thrombolysis in patients with ACI has a better therapeutic effect within 3-4.5h,and the survival rate of patients is improved.The earlier the treatment of rt-PA intravenous thrombolysis in patients with ACI is better, and more conducive to prognosis.