不同时间窗rt-PA静脉溶栓在椎-基底动脉脑梗死治疗中的效果分析

Analysis of the effect of rt-PA intravenous thrombolysis in the treatment of vertebrobasilar system cerebral infarction in different time windows

目的探讨不同时间窗重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓在椎-基底动脉脑梗死治疗中的效果,为实际应用提供参考依据。方法70例椎-基底动脉脑梗死患者,随机分为研究组和对照组,各35例。两组均进行rt-PA静脉溶栓治疗,对照组在发病4.5 h内实施溶栓治疗,研究组在发病4.5~9.0 h内实施溶栓治疗。比较两组并发症发生率及治疗前后Barthel指数量表(BI)评分、美国国立卫生研究院卒中量表(NIHSS)评分。结果治疗2周、3个月后,研究组NIHSS评分分别为(5.80±1.52)、(2.25±1.02)分,与对照组的(5.36±1.47)、(2.20±1.07)分比较,差异无统计学意义(P>0.05)。治疗2周、3个月后,研究组BI评分分别为(45.78±10.52)、(72.15±10.72)分,与对照组的(47.16±10.27)、(75.20±10.15)分比较,差异无统计学意义(P>0.05)。研究组并发症发生率为14.29%,与对照组的5.71%比较,差异无统计学意义(P>0.05)。结论将rt-PA静脉溶栓治疗时间窗扩大至9 h,仍可显著改善患者神经缺损功能,提升日常生活能力,且治疗后并发症发生率维持在较低水平,具有较高安全性,在严格遵循溶栓治疗指征前提下,具有应用价值。

Objective To discuss the effect of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis in the treatment of vertebrobasilar system cerebral infarction in different time windows,so as to provide reference for clinical practice.Methods A total of 70 patients with vertebrobasilar system cerebral infarction were randomly divided into the research group and the control group,with 35 cases in each group.Both groups received rt-PA intravenous thrombolysis,the control group received thrombolytic therapy within 4.5 h of onset,with thrombolysis administered within 4.5 h of onset in the control group and within 4.5-9.0 h of onset in the research group.The complication rate,Barthel index(BI)score and National Institutes of Health stroke scale(NIHSS)score before and after treatment were compared between the two groups.Results After 2 weeks and 3 months of treatment,the NIHSS scores of the research group were(5.80±1.52)and(2.25±1.02)points,which were not statistically significant compared with(5.36±1.47)and(2.20±1.07)points of the control group(P>0.05).After 2 weeks and 3 months of treatment,the BI scores of the research group were(45.78±10.52)and(72.15±10.72)points,which were not statistically significant compared with(47.16±10.27)and(75.20±10.15)points of the control group(P>0.05).The complication rate in the research group was 14.29%,which was not statistically significant compared with 5.71%in the control group(P>0.05).Conclusion Expanding the time window of rt-PA intravenous thrombolytic therapy to 9 h can still significantly improve the neurological deficits and enhance the activities of daily living of patients,and the complication rate after treatment is maintained at a low level with high safety,which has the value of application under the premise of strictly following the indications for thrombolytic therapy.