小剂量rt-PA静脉溶栓联合依达拉奉右莰醇治疗高龄中重度急性缺血性脑卒中的时机研究

The timing of low-dose rt-PA intravenous thrombolysis combined with edaravone dexborneol in the elderly patients with moderate to severe acute ischemic stroke

目的探讨不同时机下重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合依达拉奉右崁醇治疗高龄中重度急性缺血性脑卒中(AIS)的有效性和安全性,为AIS的临床治疗提供参考。方法选取2020年11月—2023年5月于天津市第四中心医院急诊科卒中中心接受小剂量(0.6 mg/kg)rt-PA静脉溶栓治疗的181例高龄(≥80岁)中重度AIS患者为研究对象。依据治疗方式,患者分为对照组(60例,接受rt-PA静脉溶栓治疗)、早期联合组(61例,rt-PA静脉溶栓治疗启动后即刻给予依达拉奉右崁醇治疗)和晚期联合组(60例,rt-PA静脉溶栓24 h后给予依达拉奉右崁醇治疗),比较3组患者7 d神经功能改善率、90 d预后良好率、颅内出血发生率、症状性颅内出血发生率、颅外系统性并发症发生率和90 d病死率。采用SPSS 22.0统计软件进行单因素方差分析、Mann-Whitney U检验和χ^(2)检验。结果早期联合组的7 d神经功能改善率(21.3%)和90 d预后良好率(49.2%)优于对照组(分别为6.7%和20.0%)和晚期联合组(分别为13.3%和40.0%),差异均有统计学意义(P<0.05)。早期联合组的颅内出血发生率(4.9%)和症状性颅内出血发生率(1.6%)低于对照组(分别为11.7%和6.7%)和晚期联合组(分别为10.0%和5.0%),差异均有统计学意义(P<0.05)。早期联合组的颅外系统性并发症发生率(8.2%)低于晚期联合组(13.3%),差异有统计学意义(P<0.05)。早期联合组的90 d病死率(6.6%)低于对照组(21.7%)和晚期联合组(13.3%),差异均有统计学意义(P<0.05)。结论rt-PA静脉溶栓即刻联合应用依达拉奉右崁醇可提高rt-PA静脉溶栓治疗高龄中重度AIS的有效性和安全性。

Objective To explore at different times the efficacy and safety for recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis combined with edaravone dexborneol in the elderly patients with moderate to severe acute ischemic stroke(AIS),and provide the reference for clinic treatment of AIS.Methods From November 2020 to May 2023,181 elderly patients(≥80 years old)with moderate or severe AIS treated with low-dose rt-PA(0.6 mg/kg)intravenous thrombolysis in the emergency department stroke center of the Fourth central hospital were selected as the subjects.According to the treatment method,the subjects were divided into control group(60 cases,received intravenous thrombolytic therapy with rt-PA),early combined group(61 cases,intravenous edaravone dexborneol was started during rt-PA),late combined group(60 cases,intravenous thrombolysis of rt-PA for 24 h,then treated with edaravone dexborneol).The neurological improvement rate of 7 d,good prognosis rate of 90 d,intracranial hemorrhage rate,symptomatic intracranial hemorrhage rate,extracranial systemic complications rate and 90 d mortality rate were compared in 3 groups.One-way analysis of variance,Mann-Whitney U test and χ^(2) test were used to analyze the data.The used software was SPSS 22.0.Results The neurologic improvement rate(21.3%)at 7 days and good prognosis rate(49.2%)at 90 days of the early combined group were better than those(6.7% and 20.0%)of the control group and those(13.3% and 40.0%)of the late combined group(P<0.05).The intracranial hemorrhage rate(4.9%)and symptomatic intracranial hemorrhage rate(1.6%)in the early combined combined group were lower than those(11.7% and 6.7%)in the control group and those(10.0% and 5.0%)in the late combined group(P<0.05).The extracranial systemic complication rate(8.2%)in the early combined group was significantly lower than that(13.3%)in the late combined group(P<0.05).The mortalities(6.6%)within 90 days of early combined group was significantly lower than that(21.7%)of control group and that(13.3%)of the late combined group(P<0.05).Conclusion After rt-PA intravenous thrombolysis,the immediate application of edaravone dexborneol can increase the the efficacy and safety of rt-PA intravenous thrombolysis in elderl patients with moderate to severe AIS.