低剂量阿替普酶静脉溶栓治疗急性脑梗死的疗效及安全性分析

Analysis of the efficacy and safety of intravenous thrombolytic therapy with low-dose alteplase in patients with acute cerebral infarction

目的探讨急性脑梗死患者应用低剂量阿替普酶进行静脉溶栓治疗的临床效果,并对其安全性进行分析。方法 120例急性脑梗死患者,根据治疗方法不同分为对照组及观察组,每组60例。对照组应用常规剂量阿替普酶进行溶栓治疗,观察组应用低剂量阿替普酶进行溶栓治疗。比较两组患者治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、巴氏(Barthel)指数及颅内出血、消化道出血发生情况和死亡率。结果治疗前及治疗后1周、1个月,两组NIHSS评分、Barthel指数比较,差异无统计学意义(P>0.05)。治疗后1周、1个月,两组NIHSS评分均低于本组治疗前、Barthel指数均高于本组治疗前,差异具有统计学意义(P<0.05)。治疗2周内,观察组颅内出血0例,消化道出血3例;对照组颅内出血5例,消化道出血7例。观察组颅内出血及消化道出血发生率分别为0、1.7%,均明显低于对照组的8.3%、11.7%,差异具有统计学意义(P<0.05)。6个月后随访,观察组死亡1例,死亡原因为心律失常;对照组死亡5例,死亡原因为溶栓后脑大量出血3例、肺内感染与心力衰竭2例。两组死亡率比较差异无统计学意义(P>0.05)。结论低剂量阿替普酶与常规剂量阿替普酶静脉溶栓治疗急性脑梗死均具有明显的治疗效果,但低剂量阿替普酶安全性更高,可减少颅内出血及消化道出血,值得临床推广应用。

Objective To discuss the clinical effect of intravenous thrombolytic therapy with low-dose alteplase in patients with acute cerebral infarction,and analyze its safety.Methods A total of 120 patients with acute cerebral infarction were divided into control group and observation group according to different treatment methods,with 60 cases in each group.The control group received conventional doses of alteplase for thrombolysis,and the observation group received low doses of alteplase for thrombolysis.The National Institutes of Health stroke scale(NIHSS) score and Barthel index before and after treatment,occurrence of intracranial hemorrhage,gastrointestinal hemorrhage,and mortality were compared between the two groups.Results Before treatment,1 week and 1 month after treatment,there was no statistically significant difference in NIHSS score and Barthel index between the two groups(P>0.05).1 week and 1 month after treatment,the NIHSS scores of the two groups were lower than those of this group before treatment,and the Barthel index was higher than that of this group before treatment.All the differences were statistically significant(P<0.05).Within 2 weeks of treatment,there were 0 case of intracranial hemorrhage and 3 cases of gastrointestinal hemorrhage in the observation group;there were 5 cases of intracranial hemorrhage and 7 cases of gastrointestinal hemorrhage in the control group.The incidence of intracranial hemorrhage and gastrointestinal hemorrhage in the observation group were 0 and 1.7%,which were significantly lower than 8.3% and 11.7% in the control group,and the difference was statistically significant(P<0.05).After 6 months of follow-up,there was 1 death in the observation group,and the cause of death was cardiac arrhythmia;there were 5 deaths in the control group,and the causes of death were massive cerebral hemorrhage after thrombolysis in 3 cases and intrapulmonary infection with heart failure in 2 cases.The difference in mortality between the two groups was not statistically significant(P>0.05).Conclusion Both lowdose alteplase and conventional-dose alteplase intravenous thrombolysis for acute cerebral infarction have obvious therapeutic effects,but low-dose alteplase is safer and can reduce intracranial hemorrhage and gastrointestinal hemorrhage.It is worthy of clinical promotion and application.