阿替普酶与尿激酶静脉溶栓对急性脑卒中患者预后的影响

Effect of intravenous thrombolysis with alteplase and urokinase on prognosis of patients with acute stroke

目的观察阿替普酶与尿激酶静脉溶栓对急性脑卒中患者预后的影响。方法回顾性抽取2019年1月至2021年12月于许昌市人民医院接受静脉溶栓治疗的急性缺血性脑卒中患者144例,按照溶栓药物分为阿替普酶组(74例)和尿激酶组(70例)。比较两组治疗效果、溶栓后(2、24、72 h及7d)美国国立卫生研究院卒中量表(NIHSS)评分,比较两组溶栓前后血浆同型半胱氨酸(Hcy)、纤维蛋白原(FIB)及脂蛋白a水平。两组预后于溶栓后90 d采用临床结局改良Rankin量表(mRS)评估,并比较两组不良事件发生情况。结果溶栓24 h后,阿替普酶组临床总有效率(91.89%,68/74)高于尿激酶组(80.00%,56/70),P<0.05。溶栓后2、24 h,阿替普酶组NIHSS评分低于尿激酶组(P<0.05);溶栓后72 h、7d,两组NIHSS评分比较,差异未见统计学意义(P>0.05)。溶栓后24 h,两组Hcy、FIB、脂蛋白a水平低于溶栓前,且阿替普酶组低于尿激酶组(P<0.05)。溶栓后90 d,阿替普酶组mRS评分优于尿激酶组(P<0.05),两组均未出现重度残疾和死亡患者。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论阿替普酶与尿激酶静脉溶栓对急性缺血性脑卒中均有较好的治疗效果,且阿替普酶能在较短时间内改善神经功能损害状况,预后效果略优于尿激酶。

ObjectiveTo observe the effect of intravenous thrombolysis with alteplase and urokinase on the prognosis of patients with acute stroke.MethodsA total of 144 patients with acute ischemic stroke who underwent intravenous thrombolysis in Xuchang People’s Hospital from January 2019 to December 2021 were retrospectively selected.And the patients were divided into alteplase group(74 cases)and urokinase group(70 cases)according to thrombolytic drugs.The treatment effect and National Institutes of Health stroke scale(NIHSS)score of the two groups after thrombolysis(2 hours,24 hours,72 hours and 7 days)were compared.The levels of plasma homocysteine(Hcy),fibrinogen(FIB)and lipoprotein-a were compared between the two groups before and after thrombolysis.The prognosis of the two groups were evaluated by clinical outcome modified Rankin scale(mRS)90 days after thrombolysis,and the adverse reactions of the two groups were compared.ResultsThe total clinical effective rate of the alteplase group(91.89%,68/74)was higher than that of the urokinase group(80.00%,56/70)24 hours after thrombolysis(P<0.05).The NIHSS score of the alteplase group were lower than those in the urokinase group 2 and 24 hours after thrombolysis(P<0.05).There was no significant difference in NIHSS score between the two groups 72 hours and 7 days after thrombolysis(P>0.05).Twenty-four hours after thrombolysis,the levels of Hcy,FIB and lipoprotein-a in the two groups were lower than those before thrombolysis,and these indexes in the alteplase group were lower than those in the urokinase group(P<0.05).The mRS score of the alteplase group was better than that of the urokinase group 90 days after thrombolysis(P<0.05),and there was no severe disability or death in either group.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).ConclusionsIntravenous thrombolysis with alteplase and urokinase have good therapeutic effects on acute ischemic stroke.Alteplase can improve neurological impairment in a short period of time,and can get slightly better prognosis effect than urokinase.