rt-PA静脉溶栓治疗伴维持性血液透析急性脑梗死患者的临床研究

Intravenous thrombolysis with recombinant tissue plasminogen activator in patients with acute ischemic stroke and maintenance hemodialysis

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗伴维持性血液透析(MHD)急性脑梗死患者的有效性及安全性。方法选择自2018年3月至2021年10月于南开大学附属第四中心医院卒中中心救治的235例伴MHD急性脑梗死患者进行研究。依据患者自愿选择的治疗方式,将患者分为对照组(70例,仅接受标准化二级预防治疗)、rt-PA小剂量组(85例,接受rt-PA静脉溶栓,剂量为0.6 mg/kg)和rt-PA标准剂量组(80例,接受rt-PA静脉溶栓,剂量为0.9 mg/kg),比较各组患者间有效性指标(治疗后24 h治疗有效率、7 d疗效良好率、90 d预后良好率和90 d病死率)及安全性指标(治疗后90 d内颅内出血发生率、症状性颅内出血发生率及颅外恶性出血发生率等)的差异。结果rt-PA小剂量组、rt-PA标准剂量组与对照组患者治疗后90 d预后良好率(71.8%、68.8%、64.3%)的差异无统计学意义(P>0.05),但rt-PA小剂量组及rt-PA标准剂量组患者治疗后24 h治疗有效率、7 d疗效良好率(44.7%、57.7%,46.3%、62.5%)均明显高于对照组患者(27.1%、38.6%),rt-PA小剂量组患者治疗后90 d病死率(7.1%)明显低于rt-PA标准剂量组(22.5%)及对照组患者(21.4%),颅内出血及症状性颅内出血发生率(8.2%、3.5%)均明显低于rt-PA标准剂量组患者(22.5%、16.3%),颅外并发症发生率、消化道出血发生率(5.9%、1.2%)均明显低于rt-PA标准剂量组患者(18.8%、10.0%),差异均有统计学意义(P<0.05)。结论对于伴MHD急性脑梗死患者,推荐rt-PA 0.6 mg/kg方案进行静脉溶栓治疗。

Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with maintenance hemodialysis(MHD)and acute ischemic stroke.Methods The clinical data of 235 patients with acute ischemic stroke receiving MHD were collected in our hospital from March 2018 to October 2021.According to the treatment methods chosen by themselves,these patients were divided into control group(n=70,only receiving standardized secondary stroke prevention),rt-PA low-dose group(n=85,receiving rt-PA intravenous thrombolysis,0.6 mg/kg)and rt-PA standard-dose group(n=80,receiving rt-PA intravenous thrombolysis,0.9 mg/kg).The effective rate 24 h after treatment,good efficacy rate 7 d after treatment,and good prognosis rate and mortality 90 d after treatment were used to evaluate the effectiveness.The incidences of intracranial hemorrhage,symptomatic intracranial hemorrhage,and severe extracranial hemorrhage 90 d after treatment were used to evaluate the safety.Results There was no statistical difference in the good prognosis rate 90 d after treatment among the rt-PA low-dose group,the rt-PA standard-dose group and the control group(71.8%,68.8%,and 64.3%;P>0.05),but the effective rate 24 h after treatment and good efficacy rate 7 d after treatment in the rt-PA low-dose group and rt-PA standard-dose group(44.7%,57.7%;46.3%,62.5%)were both significantly higher than those in the control group(27.1%,38.6%;P<0.05).The mortality 90 d after treatment in the rt-PA low-dose group(7.1%)was significantly lower than that in the rt-PA standard-dose group(22.5%)and control group(21.4%,P<0.05).The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in the rt-PA low-dose group(8.2%,3.5%)were significantly lower than those in the rt-PA standard-dose group(22.5%,16.3%;P<0.05),and the incidences of extracranial complications and gastrointestinal bleeding(5.9%,1.2%)were significantly lower than those in the rt-PA standard-dose group(18.8%,10.0%;P<0.05).Conclusion Intravenous thrombolytic therapy with 0.6 mg/kg rt-PA is recommended for acute ischemic stroke patients receiving MHD.