探究不同剂量的rt-PA静脉溶栓治疗急性脑梗死的疗效

Efficacy of different doses of rt-PA in treatment of acute cerebral infarction

目的探究与分析不同剂量的重组组织型纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)静脉溶栓治疗急性脑梗死的疗效。方法选取2014年5月~2015年5月进行rt-PA静脉溶栓治疗的80例急性脑梗死患者作为研究对象,根据rt-PA静脉溶栓剂使用剂量的不同分成2组,每组40例。以溶栓治疗后24 h内脑出血(intracerebral hemorrhage,ICH)、症状性脑出血(symptomatic intracerebral hemorrhage,SICH)、其他出血症状及治疗后3个月预后良好率、总死亡率评价治疗的临床疗效。通过NIHSS评分对治疗前、后2组患者的神经功能缺陷程度进行评分,分析2组治疗临床疗效与治疗前神经功能缺陷程度之间的相关性。结果标准剂量组溶栓治疗后3个月总死亡率明显高于低剂量组(P<0.05)。治疗后低剂量组NIHSS评分4~8分的比例明显多于标准剂量组(P<0.05);低剂量组NIHSS评分9~16分、17~24分的比例均明显少于标准剂量组(P<0.05)。标准剂量组NIHSS 9~16分的患者治疗后3个月的总死亡率明显高于低剂量组(P<0.05)。结论不同剂量的rt-PA静脉溶栓治疗急性脑梗死的疗效基本一致,且疗效不受神经功能缺陷程度的影响,但低剂量rt-PA治疗时更能减少患者3个月后的死亡率。

Objective To explore different doses of recombinant tissue-type plasminogen activator( rt-PA) intravenous thrombolytic therapy for acute cerebral infarction. Methods 130 patients with acute cerebral infarction were as the research subjects selected from May 2014 to May 2015 for rt-PA thrombolytic therapy,who were divided into two groups according to rt-PA thrombolytic agent dose,65 cases in each group. Evaluated the clinical efficacy of thrombolytic therapy after treatment in accordance within 24 h intracerebral hemorrhage( ICH),symptomatic intracerebral hemorrhage( SICH),other bleeding symptoms and for 3 months after treatment the prognosis was good rate,total mortality. For pre-treatment,the degree of defect nerve function after two groups of patients were scored by NIHSS score,correlation analysis between the two groups of clinical efficacy and function of the degree of nerve defect before treatment. Results 3 months after thrombolysis total mortality in the standard dose group was significantly higher than that in the low-dose group( P < 0. 05). After treatment,both groups NIHSS scores were significantly lower than before treatment( P < 0. 05); After treatment,NIHSS score 4-8 points in the proportion of low-dose group was significantly more than that in the standard dose group( P < 0. 05); NIHSS score 9-16 points,17-24 points in the proportion of low-dose group were significantly less than that in the standard dose group( P < 0. 05). NIHSS9-16 points of patients after total mortality three months in the standard-dose group was significantly higher than that in the low-dose group( P < 0. 05).Conclusion Different doses of rt-PA thrombolytic therapy in acute cerebral infarction are basically the same,and the degree of neurological deficit does not affect the efficacy,but reduce mortality in patients 3 months after low-dose rt-PA treatment,it is worth widely used in clinical practice.