大血管闭塞性脑卒中血管介入前阿替普酶剂量选择对再通时间、再灌注分级、mRS评分、成本-效用的影响

Effect of alteplase dose selection before vascular intervention on recanalization time,reperfusion grade,mRS Score and cost-effectiveness in large vascular occlusive stroke

目的探讨大血管闭塞性脑卒中血管介入前阿替普酶剂量选择对再通时间、再灌注分级、改良Rankin(Modified Rankin scale,mRS)评分、成本-效用的影响。方法按照1:1将2021年7月-2023年6月本院收治的100例大血管闭塞性脑卒中患者随机分为2组,各50例;低剂量组血管介入前予以0.6 mg/kg阿替普酶,高剂量组血管介入前予以0.9 mg/kg阿替普酶;对比2组再灌注分级、入院到动脉穿刺时间、发病至灌注时间、穿刺至灌注时间、取栓次数、美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、mRS评分、并发症发生率及成本-效用。结果低剂量组血管再通率94.00%(47/50)与高剂量组96.00%(48/50)比较无显著差异(P>0.05);低剂量组入院到动脉穿刺时间短于高剂量组(P<0.05);低剂量组发病至灌注时间、穿刺至灌注时间、取栓次数与高剂量组比较无显著差异(P>0.05);治疗2、4周后2组NIHSS评分均呈降低趋势(P<0.05),但组内比较无显著差异(P>0.05);治疗3个月后低剂量组mRS评分与高剂量组比较无显著差异(P>0.05);低剂量组并发症总发生率为0,而高剂量组为12.00%;成本-效用分析显示,低剂量组成效比(Cost/effectiveness,C/E)86.70低于高剂量组94.44,且敏感性分析与前述分析一致。结论大血管闭塞性脑卒中血管介入前采用低剂量阿替普酶不增加取栓次数,不影响血管再通时间、再灌注分级及神经功能预后,且安全性提高,成本-效用更优。

Objective To investigate the effects of alteplase dose selection before vascular intervention on recanalization time,reperfusion grade,modified Rankin(mRS)score,and cost-effectiveness in patients with large vascular occlusive stroke.Methods A total of 100 patients with large vascular occlusive stroke admitted to our hospital from July 2021 to June 2023 were randomly divided into two groups according to 1:1,with 50 cases in each group.The low-dose group was given 0.6 mg/kg alteplase before vascular intervention,and the high-dose group was given 0.9 mg/kg alteplase before vascular intervention.Reperfusion grade,time from admission to arterial puncture,time from onset to perfusion,time from puncture to perfusion,number of thrombectomies,National Institutes of Health Stroke Scale(NIHSS)score,mRS score,complication rate,and cost-effectiveness were compared between the two groups.Results There was no significant difference in vascular recirculation rate between low-dose group[94.00%(47/50)]and high-dose group[96.00%(48/50)](P>0.05).The time from admission to arterial puncture in the low-dose group was shorter than in the high-dose group(P<0.05).There were no significant differences in the time from onset to perfusion,time from puncture to perfusion,and number of thrombectomies between low-dose group and high-dose group(P>0.05).At 2 and 4 weeks after treatment,the NIHSS score of both groups showed a decreasing trend(P<0.05),but there was no significant difference in comparison between low-dose group and high-dose group(P>0.05).At 3 months after treatment,there was no significant difference in mRS scores between low-dose group and high-dose group(P>0.05).There was no significant difference in complication rate between low-dose group[0.00%(0/50)]and high-dose group[12.00%(6/50)](P>0.05).Cost-utility analysis showed that the effectiveness ratio(C/E)of 86.70 in the low-dose group was lower than 94.44 in the high-dose group,and the sensitivity analysis was consistent with the above analysis results.Conclusion Compared with the high-dose alteplase,the use of low-dose alteplase before vascular intervention in large vascular occlusive stroke does not increase the number of thrombectomies,does not affect vascular recanalization time,reperfusion grade,and functional prognosis,and improves safety and cost-effectiveness.