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观察

Observation on efficacy and prognosis of recombinant tissue-type plasminogen activator intravenous thrombolysis in patients with acute cerebral infarction(ACI)at different time windows

目的探讨不同时间窗应用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死(ACI)的临床效果。方法回顾性分析134例ACI患者临床资料,分别将发病后<3 h、3~4.5 h、4.5~6 h进行静脉溶栓治疗者纳入A组48例、B组46例与C组40例,另将6h时间窗内未予静脉溶栓的25例ACI患者纳入对照组。比较治疗前及治疗后24 h,凝血指标[血浆纤维蛋白原(FiB)、抗凝血酶Ⅲ(AT-Ⅲ)]、血液流变指标[全血低切黏度(LWBV)、血浆黏度(PV)]、脑血流灌注指标[脑血流量(CBF)、平均通过时间(MTT)]、氧化应激指标[血浆氧化低密度脂蛋白(ox-LDL)、谷胱甘肽过氧化物酶(GSH-px)]变化,分析治疗后7 d时治疗效果[美国国立卫生研究院卒中量表(NIHSS)变化率]、7 d内不良事件发生情况及治疗后3个月时康复效果[改良Rankin量表(m RS)]。结果治疗后24h,A、B、C三组血浆FiB及LWBV、PV水平均较治疗前有显著下降,均明显低于对照组,且A组与B组明显高于C组(均P<0.05)。A、B、C三组血浆AT-Ⅲ水平均较治疗前有显著提升,均明显高于对照组,且A组与B组明显低于C组(均P<0.05)。A、B、C三组CBF及血浆GSH-px水平均较治疗前有显著提升,均明显高于对照组,而MTT及血浆ox-LDL水平均较治疗前有显著下降,均明显低于对照组(均P<0.05),但A、B、C三组组间同一时间比较差异均无统计学意义(均P>0.05)。治疗后7d时,A、B、C三组治疗效果比较差异均无统计学意义(均P>0.05)。治疗后7d内,A、B、C三组症状性脑出血、脑疝、消化道出血、牙龈出血发生率均无统计学意义(均P>0.05)。治疗后3个月时,A、B、C三组mRS评分结果比较均无统计学意义(均P>0.05)。结论ACI患者在起病后6h内不同时间窗给予rt-PA均可获得较好疗效及预后,治疗方案安全可行。

Objective To explore the clinical effects of intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)at different time windows in the treatment of acute cerebral infarction(ACI).Methods The clinical data of 134 patients with ACI were retrospectively analyzed.Patients who underwent intravenous thrombolysis at<3 h,3~4.5 h and 4.5~6 h after onset were included in group A(n=48),group B(n=46)and group C(n=40).Another 25 patients with ACI who were not given intravenously thrombolysis in the 6 h time window were included in control group.The blood coagulation indicators[plasma fibrinogen(FiB),antithrombin III(AT-III)],hemodynamic indexes[lowshear whole blood viscosity(LWBV),plasma viscosity(PV)],cerebral blood perfusion indexes[cerebral blood flow(CBF),mean transit time(MTT)]and oxidative stress indexes[plasma oxidized low density lipoprotein(ox-LDL),glutathione peroxidase(GSH-px)]were compared with those before treatment and at 24 h after treatment.The treatment effects at 7 d after treatment[rate of National Institutes of HealthStroke Scale(NIHSS)change],occurrence of adverse events within 7 d and rehabilitation effects at 3 months after treatment[modified Rankin scale(mR S)]were analyzed.Results At 24 h after treatment,the levels of plasma Fi B,LWBV and PV in group A,B and C were significantly lower than those before treatment,and were significantly lower than those in control group,and the levels of group A and group B were significantly higher than those of group C(all P<0.05).The plasma AT-III levels of group A,B and C were significantly higher than those before treatment,and were significantly higher than that of control group,and the levels of group A and group B were significantly lower than that in group C(all P<0.05).The CBF and plasma GSH-px levels in groups A,B and C were significantly improved compared with those before treatment,and were significantly higher than those in control group,and the MTT and plasma ox-LDL level were significantly decreased compared with those before treatment,and were significantly lower than those in control group(all P<0.05),but there were no significant differences among groups A,B and C at the same time(all P>0.05).At 7 d after treatment,there were no statistically significant differences in the treatment effects among groups A,B and C(all P>0.05).Within 7 d after treatment,there were no statistically significant differences in the incidence rates of symptomatic cerebral hemorrhage,cerebral palsy,gastrointestinal bleeding and gingival bleeding among groups A,B and C(all P>0.05).At 3 months after treatment,there was no significant difference in the m RS score among groups A,B and C(all P>0.05).Conclusion rt-PA at different time windows for patients with ACI within 6 h after onset can obtain good efficacy and prognosis,and its treatment regimen is safe and feasible.