rt-PA溶栓时机对急性缺血性脑卒中伴心房颤动患者的溶栓效果及安全性的影响

目的 探讨rt-PA溶栓时机对急性缺血性脑卒中伴心房颤动患者的溶栓效果及安全性的影响。方法 选取本院2015年4月-2017年8月收治急性缺血性脑卒中伴心房颤动患者共124例,其中发病后3～4.5 h行rt-PA溶栓共64例设为对照组,发病后3 h内行rt-PA溶栓共60例设为观察组; 比较2组患者溶栓有效率、治疗前后NIHSS评分、随访mRS评分及严重出血事件发生率。结果 观察组患者溶栓有效率显著高于对照组(P<0.05); 2组患者治疗后1和7d NIHSS评分均显著低于治疗前(P<0.05); 观察组患者治疗后1 d NIHSS评分显著低于对照组(P<0.05); 2组患者治疗后7d NIHSS评分比较差异无显著性(P>0.05); 2组患者随访mRS评分分级情况比较差异无显著性(P>0.05); 2组患者出血性脑梗死和脑部症状性出血发生率比较差异无显著性(P>0.05); 观察组患者治疗后脑实质出血发生率显著低于对照组(P<0.05)。结论 急性缺血性脑卒中伴心房颤动患者在发病后3 h内行rt-PA溶栓在可提高溶栓效果和促进受损神经功能恢复方面较发病后3～4.5 h溶栓具有明显优势,但在远期疗效和严重出血事件发生风险方面两者接近。

The influence of thrombolytic timing of rt-PA on thrombolytic effect and safety of patients with acute ischemic stroke combined with atrial fibrillation

ObjectiveTo investigate the influence of thrombolytic timing of rt-PA on thrombolytic effect and safety of patients with acute ischemic stroke combined with atrial fibrillation.Methods 124 patients with acute cerebral infarction combined with atrial fibrillatio were chosen in the period from April 2015 to August 2017 in our hospital and divided into both group according to treatment timing,control group(64 patients)were treated with rt-PA for 3～4.5 h after morbidity and observation group(60 patients)were treated with rt-PA for <3 h after morbidity,and the thrombolysis effective rate after operation,NIHSS scores before and after treatment,mRS scores with follow-up and serious bleeding events incidence of both groups were compared.Results The thrombolysis effective rate of observation group after thrombolytic treatment was significantly higher than that of control group(P<0.05).The NIHSS scores in 1 d and 7 d after treatment of both groups were significantly lower than those before treatment(P<0.05).The NIHSS scores of observation group in 1 d after treatment were significantly lower than those of control group(P<0.05).There was no significant difference in the NIHSS scores in 7 d after treatment between 2 groups(P>0.05)There was no significant difference in the mRS scores with follow-up between 2 groups(P>0.05).There was no significant difference in the incidence of hemorrhagic infarction and symptomatic intracerebral hemorrhage between 2 groups(P>0.05).The incidence of cerebral parenchyma hemorrhage of observation group was significantly lower than that of control group(P<0.05).Conclusion Compared with rt-PA for 3～4.5 h,rt-PA for <3 h after morbidity in the treatment of patients with acute cerebral infarction combined with atrial fibrillation possessed the advantages including higher the thrombolytic effects and promoted the damaged nerve function recovery and had the same in the clinical effects for long term and the bleeding events risk.