阿替普酶静脉溶栓对高龄急性脑梗死患者的疗效与安全性

Efficacy and safety of intravenous thrombolysis with alteplase in advanced-age patients with acute cerebral infarction

目的:探讨阿替普酶静脉溶栓用于治疗高龄(≥80岁)急性脑梗死患者的疗效和安全性。方法:采用回顾性分析方法,选取西安市第一医院2017年1月-2019年12月接受阿替普酶溶栓治疗的急性脑梗死患者,按照年龄分成高龄组(≥80岁)、老年组(65~79岁)、中青年组(18~64岁)。记录3组患者的一般情况及药品不良反应发生情况。于溶栓前和溶栓后1 h、24 h、7 d采用美国国立卫生研究院卒中量表(NIHSS)评价患者神经功能缺损情况,比较溶栓后第7天总有效率,用改良Rankin’s(mRS)评分评价溶栓后短期疗效。结果:3组患者溶栓后出血并发症、溶栓后7 d总有效率、溶栓后预后极差比例均无显著性差异(P>0.05)。与溶栓前比较,高龄组和中青年组患者NIHSS评分在溶栓后24 h、7 d均显著降低(P<0.05),但高龄组患者预后良好比例低于中青年组(P<0.05)。结论:高龄急性脑梗死患者使用阿替普酶静脉溶栓有效,且安全性好。

Objective:To investigate the efficacy and safety of intravenous thrombolysis with alteplase in advanced-age patients(≥80 years old)with acute cerebral infarction.Methods:The patients with acute cerebral infarction who were treated with alteplase in Xi’an No.1 Hospital were selected as research subjects in a retrospective analysis,and were divided by age into the advanced-age group(≥80 years old),the elderly group(65-79 years old),and the young and medium-age group(18-64 years old).The general conditions and adverse drug reactions(ADRs)were recorded for the patients of the 3 groups.The National Institute of Health Stroke Scale(NIHSS)was used to evaluate neurological deficits before and after thrombolysis at 1 h,24 h and the 7th day.The total effective rates on the 7th day after thrombolysis were compared among the 3 groups.The short-term efficacy was evaluated by modified Rankin’s(mRS)scores.Results:There were no significant differences in bleeding complications,total effective rates and the proportions of the patients with poor prognosis in the 3 groups(P>0.05).The NIHSS scores of the patients in the advanced-age group and the young and medium-age group significantly decreased at 24 h and the 7th day after thrombolysis(P<0.05),but the proportion of the patients with good prognosis in the advanced-age group was lower than that in the young and medium-age group(P<0.05).Conclusion:Intravenous thrombolysis with alteplase is safe and effective for the treatment of advanced-age patients with acute cerebral infarction.