高龄脑梗死急性期患者静脉溶栓的有效性及安全性分析

Efficacy and safety of intravenous thrombolysis in very old acute cerebral infarction patients

目的探讨高龄脑梗死急性期患者静脉溶栓治疗的有效性及安全性。方法收集2018年2月~2020年2月首都医科大学附属北京朝阳医院怀柔医院神经内科发病4.5 h内静脉注射组织型纤溶酶原激活剂阿替普酶溶栓的急性脑梗死患者224例,根据发病年龄分为观察组70例(≥80岁)和对照组154例(<80岁)。比较2组基线资料,采用美国国立卫生研究院卒中量表(NIHSS)、改良的Rankin量表(mRS)评估2组的治疗效果,并观察2组出血情况、其他不良反应及安全性。结果观察组心房颤动比例明显高于对照组(37.1%vs 18.8%,P=0.003)。2组溶栓治疗效果、预后良好和病死率比较,差异无统计学意义(P>0.05)。对照组溶栓后颅内出血、消化道出血、泌尿系出血、牙龈出血和皮肤黏膜出血分别为2例(1.3%)、3例(1.9%)、3例(1.9%)、5例(3.2%)和3例(1.9%),观察组溶栓后颅内出血、消化道出血、泌尿系出血、牙龈出血和皮肤黏膜出血分别为2例(2.9%)、2例(2.9%)、3例(4.3%)、4例(5.7%)和7例(10.0%)。观察组总出血发生率明显高于对照组,差异有统计学意义(25.7%vs 10.4%,P=0.003)。结论静脉溶栓治疗高龄脑梗死急性期患者同样能获益。

Objective To study the efficacy and safety of intravenous thrombolysis in very old acute cerebral infarction(ACI)patients.Methods Two hundred and twenty-four ACI patients admitted to our hospital from February 2018 to February 2020 who received thrombolytic therapy by intraveneous injection with tissue plasmingen activator were divided into control group or<80 years old group(n=154)and observation group or≥80 years old group(n=70).Their baseline data were recorded.The therapeutic effects in two groups were assessed according to their NIHSS score and mRS score.Hemorrhage,other adverse reactions and safety were observed.Results The incidence of AF was significantly higher in observation group than in control group(37.1%vs 18.8%,P=0.003).No significant difference was detected in thrombolytic effect,good outcome and death rate between the two groups(P>0.05).Intracranial hemorrhage,digestive tract hemorrhage,urinary system hemorrhage and gingival hemorrhage were detected in 2(1.3%),3(1.9%),3(1.9%),5(3.2%),3(1.9%)patients of control group and in 2(2.9%),2(2.9%),3(4.3%),4(5.7%),7(10.0%)patients of observation group after thrombolysis.The total incidence of hemorrhage was significantly higher in observation group than in control group(25.7%vs 10.4%,P=0.003).Conclusion Intravenous thrombolysis is effective in very old ACI patients.