老年心房颤动患者急性缺血性脑卒中后静脉溶栓的安全性及有效性观察

Safety and effectivity of intravenous thrombolysis in elder patients with atrial fibrillation after acute ischemic stroke

目的探讨老年心房颤动(下称房颤)患者急性缺血性脑卒中后阿替普酶静脉溶栓治疗的安全性和有效性。方法回顾性分析2015年1月到2017年2月接受阿替普酶静脉溶栓的147例60~90岁的急性缺血性脑卒中患者,根据是否合并非瓣膜性房颤分为房颤组24例和非房颤组123例,比较两组的性别、年龄、静脉溶栓时间、改良Rankin量表评分、吸烟史、高血压病史、高脂血症病史、糖尿病史、溶栓前血压及颅内出血事件发生率。结果两组一般资料比较差异无统计学意义。房颤组患者发生颅内出血事件1例(6.5%),90d改良Rankin量表评分≤2分19例(79.2%),非房颤组发生颅内出血事件2例(1.6%),90d改良Rankin量表评分≤2分85例(69.1%),两组比较差异均无统计学意义(均P>0.05)。结论老年心房颤动患者急性缺血性脑卒中后4.5h内进行阿替普酶静脉溶栓治疗有效,不增加颅内出血风险。

Objective To determine safety and effectiveness of intravenous thrombolysis(IVT)with Alteplase in elder patients with non-valvular atrial fibrillation(AF)after acute ischemic stroke(AIS).Methods 147 patients of 60~90years old treated with alteplase IVT after AIS from Jun 2015 to fab 2017 were retrospectively analyzed and divided into AF group and non-AF group.Age,gender,IVT time,modified Rankin Scale(mRS)score,history of smoking,hypertension,hyperlipemia,diabetes mellitus,baseline blood pressure and cranial hemorrhage were compared between the two groups.Results There was no significant difference of clinical baseline data between the two groups.Cranial hemorrhage occurred in one case in AF group(6.5%)and 2 cases(1.6%)in non-AF group.90-day mRS score was≤2 in 19 patients(79.2%)in AF group and in 85 patients(69.1%)in non-AF group.There was no significant difference between the two groups.Conclusion IVT with alteplase within 4.5 hours after AIS is effective and without increasing cranial hemorrhagic risk in elder patients with non-valvular AF.