急性缺血性脑卒中患者不同时间窗静脉溶栓临床分析

Clinical analysis of intravenous thrombolysis in different time windows on patients with acute ischemic stroke

目的分析急性缺血性脑卒中(AIS)患者不同时间窗静脉溶栓的临床效果及预后。方法选择2017-01—2020-01郑州大学附属洛阳中心医院采用rt-PA静脉溶栓治疗的117例AIS患者,根据接受静脉溶栓治疗时间分为A组(发病至治疗时间≤3 h)45例,B组(3 h<发病至治疗时间≤4.5 h)48例,C组(4.5 h<发病至治疗时间≤6 h)24例,另选取同期未在6 h时间窗内行溶栓治疗的AIS患者30例为对照组。记录各组治疗1周后的临床疗效,入院时、治疗1 d后各组脑血流量(CBF)、平均通过时间(MTT),治疗前及治疗3个月后各组Barthel指数、改良Rankin量表(mRS)评分,溶栓组患者溶栓治疗后不良事件发生情况。结果A组总有效率93.33%,明显高于B、C组的79.17%、62.50%(P<0.05),且3组均明显高于对照组的33.33%(P<0.05)。治疗后1 d A、B、C组患者的MTT指标明显下降,CBF指标明显上升(P<0.05),3组下降或上升程度均大于对照组(P<0.05),但3组间比较差异均无统计学意义(P>0.05)。治疗后3个月A、B、C组患者的mRS评分明显下降,Barthel指数明显上升(P<0.05),且3组下降或上升幅度大于对照组(P<0.05);3组间比较,A组Barthel指数明显高于B、C组,mRS评分明显低于B、C组(P<0.05),B组Barthel指数明显高于C组(P<0.05),但mRS评分与C组比较差异无统计学意义(P>0.05)。A、B、C组发生出血性脑梗死、脑实质血肿、症状性出血、消化道出血、牙龈出血等不良事件差异无统计学意义(P>0.05)。结论在AIS患者起病6 h内予rt-PA治疗均有良好的疗效及预后,且治疗越早,患者临床疗效及预后可能更佳。

Objective To analyze the clinical curative effect and prognosis of intravenous thrombolysis in different time windows on patients with acute ischemic stroke(AIS).Methods A total of 117 AIS patients who underwent rt-PA intravenous thrombolysis in the hospital from January 2017 to January 2020 were enrolled.According to different intravenous thrombolysis time,they were divided into group A(45 cases,interval from onset to treatment not longer than 3h),group B(48 cases,3h<interval from onset to treatment≤4.5h)and group C(24 cases,4.5h<interval from onset to treatment≤6h).Another 30 AIS patients who did not undergo thrombolysis within 6h due to economic reasons during the same period were enrolled as control group.The clinical curative effect after 1 week of treatment,cerebral blood flow(CBF)and mean transit time(MTT)at admission and after 1 day of treatment,Barthel index and score of modified Rankin scale(mRS)before treatment and after 3 months of treatment in each group,as well as the occurrence of adverse events after thrombolysis in thrombolysis group were recorded.Results The total response rate of group A was significantly higher than that of group B and C(93.33%vs 79.17%,62.50%)(P<0.05),which in the three groups was significantly higher than that in control group(33.33%)(P<0.05).After 1 day of treatment,MTT was significantly decreased,while CBF was significantly increased in group A,B and C(P<0.05),and the decrease/increase amplitude in the three groups was greater than that in control group(P<0.05).However,the differences were not statistically significant among the three groups(P>0.05).After 3 months of treatment,mRS scores were significantly decreased,while Barthel index was significantly increased in group A,B and C(P<0.05),and the decrease/increase amplitude in the three groups was greater than that in control group(P<0.05).Barthel index in group A was significantly higher than that in group B and C,while mRS scores were significantly lower than those in group B and C(P<0.05).Barthel index in group B was significantly higher than that in group C(P<0.05),there was no significant difference in mRS score between group B and C(P>0.05).There was no significant difference in incidence of adverse events,such as hemorrhagic cerebral infarction,cerebral parenchymal hematoma,symptomatic hemorrhage,gastrointestinal hemorrhage and gingival bleeding among group A,B and C(P>0.05).Conclusion The curative effect and prognosis of rt-PA within 6h after onset are good on AIS patients.The earlier the treatment time,the better the curative effect and prognosis.