依达拉奉右莰醇在高龄中重度急性缺血性脑卒中rt-PA静脉溶栓治疗中的应用时机

Timing of edaravone dexborneol in intravenous thrombolysis with rt-PA for elderly patients with moderate to severe acute ischemic stroke

目的 探讨依达拉奉右莰醇在高龄中重度急性缺血性脑卒中(AIS)重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗中的应用时机。方法 选择rt-PA静脉溶栓救治的221例高龄中重度AIS患者,随机分为对照组70例、早期组75例、晚期组76例。对照组接受rt-PA静脉溶栓治疗,早期组在rt-PA静脉溶栓治疗启动后即刻给予依达拉奉右莰醇治疗,晚期组在rt-PA静脉溶栓24 h后给予依达拉奉右莰醇治疗。于治疗7 d时采用NIHSS评分评价神经功能改善情况,治疗90 d时采用mRS评分评价预后情况,比较三组短期疗效和长期疗效;观察24 h症状性颅内出血发生率、14 d颅外系统性并发症发生率和90 d病死率,比较三组治疗安全性。结果 三组7 d神经功能改善率、90 d预后良好率比较,早期组和晚期组均高于对照组,且早期组高于晚期组(P均<0.05)。三组24 h症状性颅内出血发生率、14 d颅外系统性并发症发生率比较,早期组低于晚期组和对照组(P均<0.05),晚期组与对照组比较差异无统计学意义(P>0.05)。三组90 d病死率比较,早期组和晚期组均低于对照组,且早期组低于晚期组(P均<0.05)。结论 高龄中重度AIS患者rt-PA静脉溶栓后即刻应用依达拉奉右莰醇可提高rt-PA静脉溶栓治疗的有效性和安全性,减少并发症的发生,改善患者预后。

Objective To investigate the timing of edaravone dexborneol in intravenous thrombolysis with recombi-nant tissue plasminogen activator(rt-PA)for elderly patients with moderate to severe acute ischemic stroke(AIS).Methods A total of 221 patients older than 80 years with moderate to severe AIS receiving intravenous thrombolysis with rt-PA were divided into the control group(70 cases received intravenous thrombolytic therapy with rt-PA),the early group(n=75,edaravone dexborneol began immediately after intravenous thrombolysis with rt-PA)and the late group(n=76,edaravone dexborneol started at 24 h after intravenous thrombolysis with rt-PA).The neurologic improvement rate at 7 days and good prognosis rate at 90 days were used to evaluate the efficacy.The short-term efficacy and long-term efficacy of the three groups were compared.The incidences of symptomatic intracranial hemorrhage within 24 h,extracranial compli-cations within 14 days and mortality within 90 days were observed,and the safety of the three groups was compared.Results The neurologic improvement rate at 7 days and the good prognosis rate at 90 days of the early group and the late group were higher than those of the control group,and those were higher in the early group than in the late group(all P<0.05).The incidences of symptomatic intracranial hemorrhage within 24 h and extracranial complications within 14 days in the early group were lower than those in the late group and control group(all P<0.05),while there were no statisti-cally significant differences between the late group and the control group(all P>0.05).The mortality rates within 90 days of the early and late groups were lower than that of the control group,and that was lower in the early group than in the late group(P<0.05).Conclusion Immediate application of edaravone dexborneol after intravenous thrombolysis with rt-PA is the optimal intervention time for elderly patients with moderate to severe AIS,which can promote the efficacy and safety,reduce complication rate and improve the prognosis of patients.