急性脑梗死应用小剂量阿替普酶静脉溶栓治疗的临床疗效及安全性分析

Analysis of clinical efficacy and safety of intravenous thrombolysis with low-dose alteplase in patients with acute cerebral infarction

目的探讨急性脑梗死患者应用小剂量阿替普酶静脉溶栓治疗的临床疗效及安全性。方法60例急性脑梗死患者,随机分为观察组和对照组,各30例。观察组采用小剂量(0.6 mg/kg)阿替普酶溶栓治疗,对照组采用大剂量(0.9 mg/kg)阿替普酶溶栓治疗。比较两组患者神经功能缺损情况及出血发生情况。结果治疗前及治疗后第1、7、14天,观察组和对照组美国国立卫生研究院卒中量表(NIHSS)评分组间比较,差异均无统计学意义(P>0.05);治疗后第1、7、14天,对照组NIHSS评分分别为(12.14±1.98)、(10.01±1.65)、(6.21±1.53)分,低于本组治疗前的(14.63±3.12)分;观察组NIHSS评分分别为(12.21±2.03)、(9.97±1.89)、(6.01±1.67)分,低于本组治疗前的(14.57±2.69)分,差异有统计学意义(P<0.05)。观察组出血发生率为16.7%,低于对照组的43.3%,差异有统计学意义(P<0.05)。结论应用大剂量和小剂量阿替普酶静脉溶栓治疗急性脑梗死患者均可有效改善其神经功能缺损情况,治疗效果相近,但小剂量阿替普酶静脉溶栓治疗时出血发生率低,值得借鉴。

Objective To discuss the clinical efficacy and safety of intravenous thrombolysis with lowdose alteplase in patients with acute cerebral infarction.Methods A total of 60 patients with acute cerebral infarction were randomly divided into observation group and control group,with 30 cases in each group.The control group was treated with low-dose(0.6 mg/kg)alteplase thrombolysis,and the control group was treated with high-dose(0.9 mg/kg)alteplase thrombolysis.The neurological deficit situation,and occurrence of bleeding were compared between the two groups.Results Before treatment,1,7 and 14 days after treatment,there was no statistically significant difference in National Institutes of Health Stroke Scale(NIHSS)score between the observation group and control group(P>0.05).1,7 and 14 days after treatment,the NIHSS score of the control group were(12.14±1.98),(10.01±1.65)and(6.21±1.53)points,which were lower than(14.63±3.12)points of this group before treatment;the NIHSS score of the observation group were(12.21±2.03),(9.97±1.89)and(6.01±1.67)points,which were lower than(14.57±2.69)points of this group before treatment.All the difference was statistically significant(P<0.05).The incidence of bleeding of the observation group was 16.7%,which was lower than 43.3%of the control group,and the difference was statistically significant(P<0.05).Conclusion Intravenous thrombolysis with low-dose alteplase and low-dose alteplase can effectively improve the neurological deficit in patients with acute cerebral infarction,and the effect of both is similar,but the incidence of bleeding in intravenous thrombolysis with low-dose alteplase is low,which is worthy of reference.