艾通立早期静脉溶栓治疗急性脑梗死——附100例病例分析

Early intravenous thrombolysis with recombinant tissuepl asminogen activator for acute cerebral infarction

目的 :评价重组组织型纤溶酶原激活剂 (rt PA)艾通立对急性脑梗死早期静脉溶栓治疗的疗效及安全性 ,同时探讨国人应用 rt PA治疗的最佳剂量。方法 :凡符合入选标准的患者随机分为 A、B、C 3组 ,A组为rt PA 0 .9mg/ kg,B组为 rt PA 0 .7mg/ kg,C组作为对照组不用 rt PA。溶栓两组先将总量中的 8mg静脉快速推入 ,剩余量在 1h内用静脉泵输入 ,总量均不超过 90 mg。观察 3组治疗后 2 4h、90 d神经功能缺损评分 ,及 90 d日常生活能力指数 (Barthel) ,同时观察 3组治疗后 3 0 d脑出血率及病死率。结果 :A组溶栓后 2 4h和90 d治愈及显效率为 41.18%和 76.47% ,90 d Barthel指数为 95～ 10 0分者占 5 8.82 % ,3 0 d脑出血率为8.82 % ,病死率为 5 .88%。 B组溶栓后 2 4h和 90 d治愈及显效率为 3 9.3 9%和 69.70 % ,90 d Barthel指数为95～ 10 0分者占 5 4.5 5 % ,3 0 d脑出血率为 9.0 9% ,病死率为 9.0 9%。C组治疗后 2 4h和 90 d治愈及显效率为2 1.2 1%和 3 0 .3 0 % ,90 d Barthel指数为 95～ 10 0分者占 2 1.2 1% ,3 0 d病死率为 9.0 9%。 90 d溶栓组显效率(73 .13 % )明显高于对照组 (3 0 .3 0 % ,P=0 .0 0 17) ,严重致残率分别为 13 .43 %和 2 4.2 4%。结论 :急性脑梗死静脉应用rt PA溶栓治疗是安全有效的 ,

Objective: To evaluate the efficacy and safety of recombinant tissue plasminogen activator (rtPA) and to explore the most suitable dosage of rt PA in the early treatment of the Chinese patients with acute cerebral infarc tion(ACI). Methods: The patients who suited for the standard were divided into three groups. Group A received rtPA at 0 9 mg/kg, group B received rtPA at 0 7 mg/kg, and group C did not receive any thrombolytic therapy. In throm bolytic groups, rtPA at 8 mg was injected intravenously in a bolus at first and th en the rest was given over 60 minutes. The maximal dosage was 90 mg. The Chinese stroke scale (CSS) and Barthel Index (BI) were used to evaluate the recovery of neurological functions after rtPA treatment for 24 hours and 90 days. The hemorrhagic rate and 30 days mortality rate were also analysed. Results: In group A the CSS significant effective rate was 41 18 percent at 24 hours and 76 47 percent at 90 days after thrombolysis. At 90 days BI significant effective rate was 58 82 perc ent. At 30 days hemorrhagic rate was 8 82 percent and mortality rate was 5 88 perc ent. In group B, the CSS significant effective rate was 39 39 percent at 24 hours and 69 70 percent at 90 days. At 90 days, BI significant effectiv e rate was 54 55 percent, and at 30 days, hemorrhagic rate was 9 09 percent and mortality rate was 9 09 percent. In group C, the CSS significant e ffecti ve rate was 21 21 percent, at 24 hours and 30 30 percent at 90 days(P>0 05). At 90 days, BI was 21 21 percent the mortality rate was 9 09 percent. At 30 days the mortality rate w as no significant difference within three groups At 90 days, significant effective rate was 73 13 percent vs. 30 30 percent in thromblytic and cont rol groups (P=0 001 7). The significant disability rate was 13 43 perent vs. 24 24 percent. Conclusions: For Chinese individuals, with ACI, rtPA thrombolytsis was effect ive and safe.The dosage of 0 9 mg/kg for foreign people als o fitted for Chinese individuals.