不同剂量阿替普酶超时间窗治疗急性缺血性脑卒中的效果

Effect of Different Doses of Alteplase in the Treatment of Acute Ischemic Stroke Beyond Time Window

目的探讨发病4.5~9.0 h的急性缺血性脑卒中(acute ischemic stroke,AIS)患者经多模式CT筛选下超时间窗应用小剂量或标准剂量阿替普酶静脉溶栓的有效性和安全性。方法回顾性分析2021年1月—2023年1月在临沂市中心医院卒中中心就诊的发病时间在4.5~9.0 h的104例AIS患者。均完善一站式多模式CT检查,采用F-stroke软件处理分析脑CT灌注成像,存在核心/灌注不匹配者,给予阿替普酶静脉溶栓,并按照采用剂量大小分为小剂量组(0.6 mg/kg体质量,n=53)与标准剂量组(0.9 mg/kg体质量,n=54)。通过对比改良RanKin评分量表(modified RanKin scale,mRS)、美国国立卫生研究院卒中量表(the National Institutes of Health stroke scale,NIHSS)评分评估临床有效性,通过比较出血性转化(hemorrhagic transformation,HT)率、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)率、泌尿道出血率、消化道出血率、病死率评估临床安全性。结果小剂量组预后良好率为58.49%(31/53),标准剂量组预后良好率为59.26%(32/54),差异无统计学意义(P>0.05)。2组溶栓后7 d NIHSS评分低于基线NIHSS评分,溶栓后90 d mRS评分低于入院时mRS评分,差异有统计学意义(P<0.05)。2组溶栓后7 d NIHSS评分、溶栓后90 d mRS评分比较,差异无统计学意义(P>0.05)。小剂量组24 h HT发生率、24 h SICH发生率、泌尿道出血发生率、消化道出血发生率、90 d病死率分别为1.89%(1/53)、1.89%(1/53)、3.77%(2/53)、1.89%(1/53)、1.89%(1/53),标准剂量组分别为9.26%(5/54)、7.41%(4/54)、1.85%(1/54)、5.56%(3/54)、1.85%(1/54),差异无统计学意义(P>0.05)。结论多模式CT筛选指导下发病在4.5~9.0 h的AIS患者超时间窗应用小剂量和标准剂量阿替普酶静脉溶栓有相似的临床疗效,小剂量更安全。

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose or standard-dose alteplase in patients with acute ischemic stroke(AIS)4.5 to 9.0 h after onset by multi-mode CT screening beyond time window.Methods A total of 104 AIS patients with onset time of 4.5 to 9.0 h in stroke center,Linyi Central Hospital from January 2021 to January 2023 were retrospectively analyzed.All patients underwent onestop multi-mode CT examination and were analyzed by F-stroke software.Those with core/perfusion mismatch were given intravenous thrombolysis with alteplase and divided into low dose group(0.6 mg/kg body weight,n=53)and standard dose group(0.9 mg/kg body weight,n=54).Clinical effectiveness was evaluated by comparing modified RanKin scale(mRS)and the National Institutes of Health stroke scale(NIHSS)scores.Their clinical safety was evaluated by comparing the rate of hemorrhagic transformation(HT),the rate of symptomatic intracranial hemorrhage(SICH),the rate of urinary tract hemorrhage,digestive tract hemorrhage,and case fatality.Results The good prognosis rate was 58.49%(31/53)in the low dose group and 59.26%(32/54)in the standard dose group,the difference was not statistically significant(P>0.05).The NIHSS score at 7 d after thrombolysis was lower than the baseline NIHSS score,and the mRS score at 90 d after thrombolysis was lower than the mRS Score at admission between the two groups,the difference was statistically significant(P<0.05).There was no significant difference in NIHSS score at 7 d after thrombolysis and mRS score at 90 d after thrombolysis between the two groups(P>0.05).The incidence of 24 h HT,incidence of 24 h SICH,urinary tract bleeding,digestive tract hemorrhage and 90 d mortality in the low dose group were 1.89%(1/53),1.89%(1/53),3.77%(2/53),1.89%(1/53)and 1.89%(1/53),respectively.The standard dose groups were 9.26%(5/54),7.41%(4/54),1.85%(1/54),5.56%(3/54)and 1.85%(1/54),respectively,the difference was not statistically significant(P>0.05).Conclusion Under the guidance of multi-mode CT screening,the application of low-dose and standard-dose alteplase intravenous thrombolysis in AIS patients with onset of 4.5 to 9.0 h beyond the time window has similar clinical efficacy,and the lowdose is safer.