重组组织型纤溶酶原激活物静脉溶栓治疗急性脑梗死的疗效

The efficiency and safety of the intravenous thrombolysis using recombinant plasminogen activator(rt-PA)for acute cerebral ischemia

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的安全性及有效性。方法选择发病4.5h内的急性脑梗死患者45例,采用rt-PA静脉溶栓,评定患者溶栓的安全性,包括症状性出血、血管再闭塞及全身其他部位出血的情况。溶栓后2h、24h和7d分别进行NIHSS评分,评价静脉溶栓治疗的有效性。结果 rt-PA静脉溶栓后发生颅内出血者6例(13.3%),其中症状性颅内出血者3例(6.7%),3例(6.7%)为非症状性颅内出血;4例(8.9%)发生血管再闭塞,其中3例病因为大动脉粥样硬化,1例病因为小血管病。未出现牙龈、消化道出血等。静脉溶栓治疗有效24例(53.3%),其中症状在溶栓后2h明显改善20例(83.3%),溶栓后24h症状明显改善4例(16.7%)。静脉溶栓无效15例(33.3%),溶栓后症状加重4例(8.9%),死亡2例(4.4%),均为心源性脑梗死患者。结论超早期rt-PA静脉溶栓是一种有效的治疗脑梗死的方法,且相对安全,对于心源性及NIHSS评分较高的患者,应严格遵守静脉溶栓适应证并充分告知患者或家属相关风险。

Objective To observe the efficiency and safety of the intravenous thrombolysis using recombinant plasminogen activator (rt-PA) for acute cerebral ischemia. Methods 45 acute cerebral ischemia patients within 4.5h of the onset of stroke were included. They were all given rt-PA for intravenous thrombolysis. The safety of the therapy was assessed through the rate of the secondary intracerebral hemorrhage ,the reocclusion ,and the abnormal bleeding. The efficiency was assessed through the NIHSS scores at the time of 2h ,24h and 7d after the therapy. Results There were 6 patients (13.3% ) who had secondary intracerebral hemorrhage. Among them ,3 patients (6.7% ) had symptomatic intracranial hemorrhage ,other 3 pa-tients (6.7% ) had non-symptomatic intracranial hemorrhage. Four patients (8.9% ) had reocclusion ,among these patients , three were atherosclerosis and the other one was small vessel disease. No patients had gingival or gastrointestinal bleeding. 24 patients (53.3% ) benefited from the thrombolytic therapy. Among them ,the symptoms of 20 patients significantly improved in 2 h after the therapy ,and the symptoms of the other 4 patients obviously improved in 24h after the therapy. Fifteen patients (33.3% ) had no changes ,4 patients (8.9% ) had deterioration ,and 2 patients (4.4% ) died.Conclusion Intravenous throm-bolysis with rt-PA is an effective method for the treatment of cerebral infarction. It is relatively safe ,however ,thrombolytic therapy should be strictly compliance with the indications for patients with cardiogenic cerebral infarction or higher NIHSS score ,and the associated risks should be fully informed to the patients or their families.