不同部位脑梗死应用阿替普酶静脉溶栓的疗效分析

目的探讨阿替普酶(rt-PA)治疗不同部位急性脑梗死的临床疗效以及影响疗效的相关因素。方法选取2019年11月至2021年4月于安徽医科大学附属巢湖医院神经内科住院行rt-PA静脉溶栓的急性脑梗死(ACI)患者123例,依据梗死部位分为前循环组(ACS,n=89)和后循环组(PCS,n=34)。通过观察rt-PA静脉溶栓后7天的NIHSS评分变化,比较分析前、后循环脑梗死rt-PA静脉溶栓的疗效差异。结果ACS组的女性比例高于PCS组,发病至溶栓的时间短于PCS组,差异有统计学意义(P<0.05)。PCS组rt-PA静脉溶栓的有效率为85.3%,高于ACS组(67.4%),差异有统计学意义(P<0.05)。二元logistic回归分析显示,梗死部位(前循环,OR=4.782,95%CI:1.162〜19.671)、入院时NIHSS评分(OR=1.189,95%CI:1.090〜1.298)、糖化血红蛋白(OR=2.422,95%CI:1.497〜3.919)是rt-PA静脉溶栓疗效较差的独立危险因素(P<0.05)。结论rt-PA静脉溶栓对PCS患者更有效。

Objective To explore the clinical efficacy of alteplase(rt-PA)in the treatment of different acute cerebral infarction(ACI)site and the related factors affecting the clinical effect.Methods From November 2019 to April 2021,a total of 123 ACI patients treated with rt-PA intravenous thrombolysis and hospitalized in the Department of Neurology,Chaohu Hospital Affiliated to Anhui Medical University were selected.According to the infarct location,the patients were divided into the anterior circulation group(ACS,n=89)and the posterior circulation group(PCS,n=34).By comparing the changes of NIHSS score after 7 days,the differences of clinical efficacy treated with rt-PA intravenous thrombolysis in anterior and posterior circulation cerebral infarction were explored.Results The proportion of women in the ACS group was higher than that in the PCS group,and the onset-thrombolysis time was shorter than that in the PCS group,with statistical significance(P<0.05).The effective rate of rt-PA intravenous thrombolysis in the PCS group was higher than that in the ACS group,with statistical significance(85.3%VS.67.4%,P<0.05).Binary logistic regression results showed that the site(anterior circulation,OR=4.782,95%CI:1.162~19.671),NIHSS score at admission(OR=1.189,95%CI:1.09~1.298),glycosylated hemoglobin(OR=2.422,95%CI:1.497~3.919)were independent risk factors for poor efficacy of intravenous thrombolysis with rt-PA(P<0.05).Conclusion Rt-PA intravenous thrombolysis is more effective for PCS patients.