轻型脑卒中患者阿替普酶静脉溶栓治疗的有效性和安全性

The therapeutic effect and safety of intravenous thrombolysis with alteplase in patients with mild stroke

目的探讨静脉溶栓治疗轻型脑卒中患者的有效性和安全性。方法回顾性分析2017年12月至2019年12月收治于我院的发病4.5 h内、美国国立卫生研究院卒中量表(NIHSS)评分≤5分的轻型缺血性脑卒中患者95例,其中溶栓组45例,未溶栓组50例。比较两组患者基线资料、ΔNIHSS(入院NIHSS评分-出院NIHSS评分)、出院时改良Rankin′s量表评分(mRS)、90 d随访时mRS评分判断预后,同时比较两组治疗相关并发症发生率,并分析其安全性。结果两组患者基线资料比较,差异无统计学意义(P>0.05)。溶栓组患者ΔNIHSS高于未溶栓组,差异有统计学意义(P<0.05);溶栓组患者出院时mRS评分0~2分者多于未溶栓组,差异有统计学意义(P<0.05);溶栓组患者90 d mRS评分0~2分者多于未溶栓组,但差异无统计学意义(P>0.05)。溶栓组患者发生治疗相关并发症4例,均为溶栓过程中牙龈出血,发生率为8.89%;未溶栓组患者均未发生治疗相关出血并发症,发生率为0.00%,组间比较差异有统计学意义(P<0.05),两组患者均未出现颅内出血、消化道出血等严重并发症。溶栓组死亡率为2.22%,未溶栓组死亡率为2.00%,两组患者死亡率比较,差异无统计学意义(P>0.05)。结论阿替普酶静脉溶栓治疗轻型脑卒中患者是可以获益的,并不增加颅内出血等严重不良事件的发生率及死亡率,安全性好。

Objective To explore the efficacy and safety of intravenous thrombolysis with alteplase in the treatment of patients with mild stroke.Methods Ninety-five mild ischemia with a score of≤5 on the National Institutes of Health Stroke Scale(NIHSS)within 4.5 hours of onset in our hospital from December 2017 to December 2019 were retrospectively analyzed,including 45 in the thrombolysis group and 50 in the non-thrombolysis group.Baseline data,ΔNIHSS(admission NIHSS score-discharge NIHSS score),modified Rankin′s scale score(mRS)at discharge,mRS score at 90 days follow-up were used to judge the prognosis.The treatment-related complications occurred between the two groups were compared.Its safety was analyzed.Results There was no significant difference in baseline data between the two groups.The ΔNIHSS(admission NIHSS score-discharge NIHSS score)of the thrombolysis group was higher than that of the non-thrombolysis group,and the difference was statistically significant(P<0.05).The patients with mRS score of 0 to 2 points in the thrombolysis group on discharge were more than those in non-thrombolysis group,and the difference was statistically significant(P<0.05).Patients with a 90-day mRS score of 0-2 in the thrombolysis group were more than those in the non-thrombolysis group,but the difference was not statistically significant(P>0.05).There were 4 cases of treatment-related complications in the thrombolysis group,all of which were bleeding gums during thrombolysis,and the incidence rate was 8.89%.None of the patients in the thrombolysis group had treatment-related bleeding complications,with the incidence rate of 0.00%,and the difference between the two It was statistically significant(P<0.05).There were no serious complications such as intracranial hemorrhage and gastrointestinal bleeding in both groups.The mortality rate in the thrombolysis group was 2.22%,and the mortality rate in the non-thrombolytic group was 2.00%.There was no statistically significant difference in mortality between the two groups(P>0.05).Conclusion Intravenous thrombolysis with alteplase can benefit patients with mild stroke.It does not increase the incidence and mortality of serious adverse events such as intracranial hemorrhage,and is safe.