急性缺血性卒中预超窗患者接受不同溶栓方案的效果及安全性研究

Efficacy and safety of two different thrombolytic therapies for patients with hyperacute ischemic stroke

目的比较首次发病后3.5〜4.5 h到院的急性缺血性卒中患者使用阿替普酶或尿激酶静脉溶栓的效果和安全性。方法前瞻性收集2019年1月一2020年10月石河子市人民医院收治的超早期的预超窗急性缺血性卒中患者,分析阿替普酶组和尿激酶组患者治疗后的第7天和第90天的美国国立卫生研究院卒中量表(National Insititutes of Health Stroke Scale,NIHSS)评分,治疗后第90天的改良Rankin量表(modified Rankin Scale,mRS)评分和Blessed行为量表(Blessed Behavior Scale,BBS)评分,以及溶栓后36h以内的症状性出血发生率。结果共96例患者接受静脉溶栓治疗,其中阿替普酶组58例,尿激酶组38例。两组患者治疗前NIHSS、mRS、BBS评分差异均无统计学意义(P>0.05)。治疗后第90天阿替普酶组NIHSS、mRS、BBS评分分别为(3.59±3.73)、(2.26±1.26)、(15.33±8.28)分,尿激酶组分别为(5.95±4.88)、(3.00±0.87)、(20.37±11.80)分,两组差异均有统计学意义(P<0.05)。两组治疗后36 h内症状性出血发生率差异无统计学意义(P>0.05)。多重线性回归分析结果显示,治疗方法与第7天NIHSS评分、第90天NIHSS评分、第90天mRS评分、第90天BBS评分有关(P<0.05),心脏病史与第90天mRS评分有关(P<0.05),收入与第90天BBS评分有关(P<0.05)。结论对于急性缺血性卒中预超窗患者,接受阿替普酶方案可能优于尿激酶方案。

Objective To observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.Methods Clinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected.The National Institutes of Health Stroke Scale(NIHSS)score on the 7th day and the 90th day,the modified Rankin Scale(mRS)score and the Blessed Behavior Scale(BBS)score on the 90th day,and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment(the alteplase group)and the ones receiving urokinase treatment(the urokinase group).Results Totally 96 patients were treated with intravenous thrombolysis.Among them,58 patients received alteplase threatment and 38 received urokinase treatment.The difference in NIHSS,mRS,or BBS scores between the two groups before treatment was not statistically significant(P>0.05).On the 90th day after treatment,the NIHSS,mRS,and BBS scores of the alteplase group were 3.59±3.73,2.26±1.26,and 15.33±8.28,respectively,and those of the urokinase group were 5.95±4.88,3.00±0.87,and 20.37±11.80,respectively;the differences between the two groups were all statistically significant(P<0.05).There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment(P>0.05).Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day,the NIHSS score on the 90th day,the mRS score on the 90th day,and the BBS score on the 90th day(P<0.05),the history of heart disease was related to the mRS score on the 90th day(P<0.05),and the income was related to the BBS score on the 90th day(P<0.05).Conclusion For the hyperactue ischemic stroke,the overall effect of alteplase treatment may be better than that of urokinase treatment.