重组组织型纤溶酶原激活剂静脉溶栓治疗心源性脑栓塞的临床研究

目的 探讨重组组织型纤溶酶原激活剂(rt-PA)治疗急性心源性脑栓塞(CCE)的安全性及疗效.方法 符合入选标准的患者溶栓组19例,对照组21例,发病3h内给予rt-PA(0.9 mg/kg)静脉溶栓治疗,采用美国国立卫生院神经功能缺损评分及Barthel指数,评定溶栓前及溶栓后2、6 h、1、3、7、30、90 d的疗效及安全性.结果 溶栓后各时间点NIHSS评分均有显著改善(P＜0.05),溶栓组临床总有效率89.5%,对照组38.1%.溶栓组脑出血发生率为10.5%,其中症状性脑出血发生率5.26%.对照组脑出血发生率19%,其中症状性脑出血发生率4.76%.溶栓组病死率0,对照组病死率9.5%.结论 CCE患者3 h内给予rt-PA静脉溶栓治疗是安全有效的.

Study of thrombolytic therapy with intravenous recombinant tissue-type plasminogen activator for cardiogenic cerebral embolism

Objective To investigate the safety and efficacy of thrombolysis with recombinant tissue-type plasminogen activator(rt-PA) in the treatment of acute cardiogenic cerebral embolism(CCE).Methods 19 cases were included in the thrombolysis group,and 21 cases in the control group.In the thrombolysis group,the patients within an onset within 3 hours were given rt-PA(0.9 mg/kg) for intravenous thrombolytic therapy,using neurological deficit score of National Institutes of Health in the U.S.and Barthel index,so as to assess the efficacy and safety before thrombolysis and 2 h,6 h,1 d,3 d,7 d,30 d,90 d respectively after thrombolysis.Results After thrombolysis,NIHSS scores at each time point are significantly improved(P<0.05),and the total clinical effective rate was 89.5%;while there was 38.1% in the control group.The intracerebral hemorrhage rate in thrombolysis group was 10.5%,5.26% of which was symptomatic intracranial hemorrhage rate.Meanwhile,the intracerebral hemorrhage rate in the control group was 19%,with symptomatic intracranial hemorrhage rate of 4.76%.Thrombolysis mortality in the thrombolysis group was 0,while mortality rate of the control group was 9.5%.Conclusions It could be safe and effective for patients with CCE to receive intravenous thrombolysis with rt-PA within 3 hours of the onset.