替奈普酶动静脉溶栓治疗急性缺血性脑卒中的对比观察

Efficacy and safety of intravenous and intra-arterial thrombolysis with tenecteplase in patients with acute is chemic stroke:a comparative study

目的 比较替奈普酶溶栓治疗急性缺血性脑卒中时静脉溶栓和动脉溶栓的有效性和安全性的差异.方法 回顾性分析本院自2015年1月~2017年12月连续登记在库的急性缺血性脑卒中患者的临床资料,包括患者入院时人口学特征、溶栓时间窗、院内时间延误、溶栓途径、替奈普酶剂量、脑卒中严重程度、各项生化和凝血指标及溶栓前重要生命体征,以及CT表现和脑卒中TOAST分型.评价溶栓后出血性转化、血管再通分级和溶栓后30d预后及死亡率.采用变量筛选技术挑选影响预后的可能因素,并用二元Logistic回归模型分析独立影响因素.结果 本研究共入选192例患者,2例失访,其中男性86例(44.8%),女性106例(55.2%);平均年龄(73.5±3.3)岁,体质量(58.6±5.8)kg;溶栓时间窗(4.5±0.5)h;静脉溶栓128例,动脉溶栓64例;溶栓后30d预后良好率为43.8%,死亡率为15.8%.单因素分析显示,动脉溶栓组较静脉溶栓组男性患者比例较高(72.5%VS 31.6%),院内延误时间(3.17h VS 1.73h)和溶栓时间窗(5.54h VS 3.58h)明显延长,替奈普酶用量明显偏少(10mg VS 30mg),差异均有统计学意义(P<0.05);两组溶栓后36h内责任血管再通率(64.9%VS 53.8%)、出血转化率(25%VS 31.3%)、30d预后良好比例(45.3%VS 40.6%)和死亡率(14.7%VS 13.2%)比较差异均无统计学意义(P>0.05).多因素Logistic回归显示溶栓方式对预后无显著影响(OR=0.54,P=0.824,95%CI:0.00~131.46):血管再通良好是预后良好独立保护因素(OR=O.11,P=-O.027,95%CI:0.02~0.781),但不同溶栓方式对血管再通无显著影响.结论 在急性缺血性脑卒中溶栓治疗中,替奈普酶动脉溶栓和静脉溶栓后30d预后良好比例相当,溶栓后出血转化率和死亡率无明显差异,不同溶栓方式对临床结局无影响.

Objective To compare the efficacy and safety of intravenous and intra-arterial thrombolysis with tenecteplase in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,consecutively registered in our database from 2015 to 2017,were included.Admission demographics,time window,procedure delay in hospital,route of thrombolysis,dose of tenecteplase,stroke severity,laboratory tests and vital signs of these patients were collected.CT manifestations and TOAST subtypes were observed.Outcome variables included hemorrhagic transformation,re-canalization of responsible vessels,favorable functional outcome 30 d after thrombolysis and mortality were evaluated.Univariate and multivariate logistic regression were used to select the potential variables and compare the diferences between the two kinds of route in thrombolysis.Results A total of 192 patients were included with two loss of follow-up.eighty-six(44.8%)were male and 106 female;average age was(73.5±3.3)years,average body weight(58.6±5.8)kilograms,and average time window(4.5±0.5)hours.one hundred and twenty-eight patients received intravenous thrombolysis and 64 patients intra-arterial thrombolysis.Favorable outcome was achieved in 43.8%patients and 30 d after thrombolysis with a mortality reaching 17.9%.Univariate analysis showed intra-arterial thrombolysis had a longer procedure delay(3.17 VS 1.73 hours)and time window(5.54 VS 3.58 hours),and lower dose(10 VS 30 mg)as compared with intravenous thromboysis(P<0.05);however,no significant differences were found between the 2 groups in re-canalization of responsible vessels(64.9%VS 53.8%),hemorrhagic transform ation(25%VS 31.3%),favorable outcome(45.3%VS 40.6%)and mortality(14.7%VS 13.2%).Multivariate logistic regression indicated that route of thrombolysis did not predict unfavorable outcome(OR=0.54,P=-0.824,95%CI:0.00~131.46);re-canalization could independently predict the functional outcome(OR=0.11,P=-0.027,95%CI:0.02~0.78),while the route of thrombolysis itself did not influence the re-canlization.Conclusion In patients with acute ischemic stroke,the treatmente efficacy and safety of in travenous and intra-arterial thrombolysis with tenecteplase are similar,not enjoying significant difference in hemorhagic transformation and mortality.