不同年龄后循环急性脑梗死患者阿替普酶静脉溶栓疗效及安全性分析

Efficacy and safety of intravenous thrombolysis with alteplase in patients with acute cerebral infarction in posterior circulation at different ages

目的探究不同年龄后循环急性脑梗死患者阿替普酶静脉溶栓的疗效及安全性。方法选取2017年2月至2020年3月在江苏省淮安市第一人民医院接受阿替普酶静脉溶栓治疗的150例后循环急性脑梗死患者,根据年龄分为A组(年龄<65岁)、B组(年龄65~80岁)、C组(年龄>80岁),各50例。比较3组患者治疗效果、疗效维持时间、治疗后不同时间美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin(mRS)评分、死亡情况和不良反应发生情况。结果治疗后14 d,3组患者有效率组间差异无统计学意义(P>0.05)。C组平均疗效维持时间长于A、B组[(8.3±2.4)d比(6.5±1.7)、(6.8±1.8)d],差异有统计学意义(P<0.05)。C组治疗后1、7 d的NIHSS评分高于A、B组[(7.5±2.1)分比(6.1±1.7)、(6.3±1.8)分;(6.2±1.7)分比(5.2±1.4)、(5.1±1.3)分],差异均有统计学意义(均P<0.05)。3组治疗后14、30 d的NIHSS和mRS评分差异均无统计学意义(均P>0.05)。治疗14、30 d,3组病死率比较差异均无统计学意义(均P>0.05)。3组不良反应发生率比较差异无统计学意义(P=0.726)。结论阿替普酶在>80岁的后循环急性脑梗死患者中应用的安全性和有效性较高,疗效维持时间长于年龄≤80岁的患者。

Objective To explore the efficacy and safety of intravenous thrombolysis with alteplase in patients with acute cerebral infarction in posterior circulation at different ages.Methods A total of 150 patients with acute posterior circulation cerebral infarction who received intravenous thrombolytic therapy with alteplase from February2017 to March 2020 in Huai’an First People’s Hospital,Jiangsu Province were selected and divided into group A(age<65 years),group B(age 65-80 years),group C(age>80 years),with 50 cases in each group.The treatment effect,duration of curative efficacy,National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin(mRS)score,mortality and adverse reactions were compared among the three groups.Results After 14 d of treatment,there were no significant differences in the effective rate among the three groups(P>0.05).The mean curative effective duration of group C was longer than that of group A and group B[(8.3±2.4)d vs(6.5±1.7),(6.8±1.8)d](P<0.05).At 1 and 7 d after treatment,NIHSS scores of group C were higher than those of group A and group B[(7.5±2.1)vs(6.1±1.7),(6.3±1.8);(6.2±1.7)vs(5.2±1.4),(5.1±1.3)](all P<0.05).There were no significant differences in NIHSS and mRS scores among the three groups at 14 and 30 d after treatment(all P>0.05).There were no significant differences in mortality among three groups at 14 and 30 d after treatment(both P>0.05).There were no significant differences in the incidence of adverse reactions among three groups(P=0.726).Conclusion Alteplase is safe and effective in patients age>80 years with acute posterior circulation cerebral infarction,and the duration of curative effect is longer than that of patients aged≤80 years.