rt-PA治疗急性轻型缺血性脑卒中的疗效分析

Therapeutic effect of intravenous thrombolysis with rt-PA on acute mild ischemic stroke

目的探讨重组组织型纤溶酶原激活剂(rt-PA)治疗NIHSS≤5分的轻型急性缺血性脑卒中的疗效及安全性。方法回顾性分析2018年1月-2019年4月在上海市嘉定区中心医院神经内科病房住院的发病≤4.5 h的急性缺血性脑卒中患者115例,其中基线NIHSS≤5分58例,NIHSS>5分57例。比较两组基线资料,并比较两组治疗后24 h、7 d、90 d NIHSS评分下降率及下降分值判断疗效,7 d、90 d改良Rankin's量表(mRS)评分判断预后,同时比两组间死亡比例及出血并发症发生率判断安全性。结果轻型卒中组在静脉溶栓后24 h、7 d及90 d NIHSS评分较基线NIHSS评分下降的比例均要高于非轻型卒中组,但仅在90 d NIHSS下降率上两者差异有统计学意义(P<0.05);轻型卒中组7 d和90 d mRS评分均要低于非轻型卒中组(P<0.01),轻型卒中组90 d mRS预后良好(mRS评分0~2分)的比例要显著高于非轻型卒中组(P=0.000);轻型卒中组的出血转化率和死亡比例均要明显低于非轻型卒中组(P<0.01)。结论对NIHSS≤5分轻型脑卒中患者进行rt-PA静脉溶栓安全有效。

Objective To investigate the efficacy and safety of recombinant tissue plasminogen activator(rt-PA)in the treatment of mild acute ischemic stroke with NIHSS≤5 points.Methods A retrospective analysis was performed on 115 patients with acute ischemic stroke≤4.5 h who were admitted to the Department of Neurology in Shanghai Jiading District Central Hospital from January 2018 to April 2019.Among them,58 cases had baseline NIHSS≤5 points and 57 cases had NIHSS>5 points.The baseline data of two groups were compared,and the rate of decline of NIHSS score and the decrease of score were compared after treatment for 24 h,7 d and 90 d in two groups.The score of the modified Rankin's scale(mRS)on day 7 and day 90 was compared to determine the prognosis,and the safety was judged by the death rate and the incidence of bleeding complications between two groups.Results The reduction rate of NIHSS scores of mild stroke group were significantly lower than that of non-mild stroke group at 24 h,7 d and 90 d after intravenous thrombolysis,but the difference was only statistically significant at the rate of 90 d NIHSS(P<0.05).The mRS scores of the mild stroke group at 7 d and 90 d were lower than those of non-mild stroke group(P<0.01).The proportion of mRS with good prognosis on 90 d in mild stroke group(mRS score 0-2)was significantly higher than that in non-mild stroke group(P=0.000).The incidence of intracranial hemorrhage and death rates of mild stroke group were significantly lower than those of non-mild stroke group(P<0.01).Conclusion Intravenous thrombolysis with rt-PA was safe and effective in patients with mild acute ischemic stroke(NIHSS≤5 points).