心房颤动在不同时机下对脑梗死患者阿替普酶静脉溶栓效果的影响研究

Impacts of atrial fibrillation on the efficacy of intravenous thrombolysis with alteplase at multiple therapeutic time windows in patients with cerebral infarction

目的探讨心房颤动在不同时机下对脑梗死患者阿替普酶静脉溶栓效果的影响。方法选取2015年1月~2017年1月就诊于我科的超急性期脑梗死患者73例为研究对象,根据发病时间分为<3 h组(n=32)与3~6 h组(n=41),并根据是否合并有心房颤动分为房颤组(n=18)与非房颤组(n=55),统计分析各组患者的临床疗效、mRS评分。结果溶栓后1 d、1周、2周<3 h组中房颤组治疗的总有效率分别为45.5%、54.5%、63.6%,非房颤组治疗的总有效率分别为57.1%、66.7%、71.4%;3~6 h组中房颤组治疗的总有效率分别为42.9%、57.1%、71.4%,非房颤组治疗的总有效率分别为44.1%、61.8%、67.6%。<3 h组、3~6 h组中房颤组、非房颤组患者治疗的总有效率之间的差异均不显著(P>0.05)。<3 h组、3~6 h组中房颤组、非房颤组患者的mRS评分之间的差异均不显著(P>0.05)。结论心房颤动在不同时机下使用阿替普酶静脉溶栓对脑梗死患者治疗效果无影响,值得临床重视。

Objective To investigate impacts of atrial fibrillation(AF)on the efficacy of intravenous thrombolysis with alteplase at multiple therapeutic time windows in patients with cerebral infarction(CI).Methods Seventy-three patients with super acute CI admitted in our department from January 2015 to January 2017 were selected as subjects.Based on the therapeutic time window from the onset of CI to the time that patients were divided into the<3 h group(n=32)and the 3-6 h group(n=41).They were also divided into the AF group(n=18)and the non-AF group(n=55)depending on whether this complication occurred.Clinical efficacy and mortality risk scores(mRS)of all groups were statistically analyzed.Results Total effective rates in the AF subgroup of the<3 h group were 45.5%,54.5%and 63.6%at 1 day,1 week and 2 weeks after intravenous thrombolysis.The total effective rates in the non-AF subgroup of the<3 h group were 57.1%,66.7%and 71.4%at the three time points.In the 3-6 h group,the total effective rates in the AF subgroup were 42.9%,57.1%and 71.4%,and the total effective rates in the non-AF subgroup 44.1%,61.8%and 67.6%at these time points.In the<3 h group 3-6 h group,there were no significant differences in total effective rates between the AF and non-AF subgroups(P>0.05).In both<3 h and 3-6 h groups,there were no significant differences in mRS between the two subgroups(P>0.05).Conclusion There were no impacts of AF on the efficacy of intravenous thrombolysis with alteplase at multiple therapeutic time windows in CI patients,which was worth more attentions in clinical practices.