MR筛选下4.5~9 h缺血性脑卒中阿替普酶静脉溶栓联合标准Ⅱ级预防治疗的效果及安全性分析

Analysis on the efficacy and safety of intravenous thrombolytic therapy with Alteplase combined with standard gradeⅡpreventive treatment in 4.5-9 hours IS under MR screening

目的:评价MR筛选下4.5~9 h缺血性脑卒中(IS)患者行阿替普酶静脉溶栓治疗的效果及安全性。方法:选取医院收治的83例发病至入院时间在4.5~9 h的IS患者,按照随机数表法将其分为溶栓组(42例)和常规组(41例)。所有患者均行MR多序列扫描,溶栓组予以阿替普酶溶栓+标准Ⅱ级预防治疗、常规组予以标准Ⅱ级预防治疗。评价两组疗效、美国国立卫生研究院卒中量表(NIHSS)评分变化及预后,测定治疗前和治疗1周两组血清白介素(IL)-1β、IL-8及肿瘤坏死因子-α(TNF-α)水平。结果:溶栓组治疗总有效率为76.19%,低于常规组的80.49%。两组治疗后24 h及1周NIHSS较治疗前均明显下降,但NIHSS评分对比差异无统计学意义(t=1.338,t=1.264;P>0.05);两组治疗后血清IL-1β、IL-8及TNF-α水平与治疗前比较均明显下降,但差异无统计学意义(t=1.977,t=1.140,t=1.858;P>0.05);溶栓组90 d预后良好率、病死率和症状性颅内出血率分别为45.24%、2.38%和4.76%,常规组分别为48.78%、2.44%和2.44%,差异无统计学意义(x^(2)=0.105,x^(2)=0.01;P>0.05)。结论:MR筛选下4.5~9 h的IS患者行阿替普酶溶栓+标准药物治疗效果及安全性与标准药物治疗相当,临床可借鉴应用。

Objective:To evaluate the efficacy and safety of intravenous thrombolytic therapy with Alteplase in patients with 4.5-9 hours ischemic stroke(IS)under MR screening.Methods:83 patients with IS which time was 4.5-9 hours from onset to admission to hospital were selected.And they were divided into thrombolysis group(42 cases)and routine group(41 cases)according to the random number table method.All of them underwent multi sequence scan of magnetic resonance(MR),and thrombolysis group received“Alteplase thrombolysis+standard grade II preventive treatment”,and routine group received only standard grade II preventive treatment.The efficacies,the changes of National Institutes of Health Stroke Scale(NIHSS)score and the prognoses of the two groups were evaluated.The serum interleukin(IL)-1β,IL-8,and tumor necrosis factor-α(TNF-α)levels of the two groups before the treatment and at the 1th week after the treatment were measured.Results:The total effective rate of the treatment of thrombolysis group was 76.19%,which was lower than 80.49%of routine group.The NIHSS scores of two groups at the 24th hour and the 1th week post treatment were lower than those pretreatment,while the differences of those between them were not significant(t=1.338,t=1.264,P>0.05).The serum IL-1β,IL-8 and TNF-αlevels of two groups after treatment were obviously decreased,while the differences of them were no significant(t=1.977,t=1.140,t=1.858,P<0.05).And the prognostic favorable rate,fatality rate and symptomatically intracranial hemorrhage rate at 90th day of thrombolysis group were 45.24%,2.38%and 4.76%,respectively,which were not statistically difference from the 48.78%,2.44%and 2.44%of the routine group(x2=0.105,x2=0.01,P>0.05).Conclusion:The efficacy and safety of the treatment of Alteplase thrombolysis+standard medicine under MR screening for IS patients with 4.5-9h are equivalent to standard medicine treatment,and clinical application of this method can be referred.