rt-PA静脉溶栓治疗急性脑梗死的研究

目的观察重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗早期急性脑梗死的疗效和安全性。方法将75例急性脑梗死(发病时间<3 h)患者随机分为2组:溶栓组40例用rt-PA 0.9 mg/kg,先于2 min内静脉注射总量中的10%,再将余量于1 h内静脉泵入;对照组35例不使用rt-PA。2组其他治疗均相同。观察治疗前及治疗后6 h、24 h、7 d3、0 d、90 d的临床神经功能缺损程度评分(CSS),治疗前、治疗后90 d日常生活活动量表(Barthel指数),30 d脑出血率、病死率。结果溶栓组溶栓后6 h、24 h、7 d、30 d、90 d CSS为15.38,13.24,9.30,7.40,5.00分;90 d总显效率为76%;90 d Barthel指数评分为95~100分者占57%;脑出血率为10%;病死率为5%。对照组治疗后6 h2、4 h7、d、30 d、90 d CSS为20.65,18.78,14.90,13.00,11.95分;90 d总显效率为30%;90 d Barthel指数评分为95~100分者占22%;无颅内出血;病死率为9%。溶栓组CSS明显低于对照组(P<0.01),总显效率明显高于对照组(P<0.01)。结论急性脑梗死早期应用rt-PA静脉溶栓是安全有效的。

Study of rt-PA intravenous thrombolysis on acute cerebral infarction

Objective It is to observe the efficacy and safety of recombinant tissue plasminogen activator(rt-PA) intravenous thrombolysis on patients with early acute cerebral infarction.Methods 75 cases of acute cerebral infarction within 3 hours from the onset of stroke were randomly divided into two groups: intravenous thrombolysis group(40 cases) and control group(35 cases).rt-PA was administrated in a dose of 0.9mg/kg,10% of total dose was injected intravenously in 2 minutes,and the rest was infused in 1 hour for intravenous thrombolysis group.The control group received only routine treatment.Scoring Clinical Stroke Scale(CSS) before treatment,in 24 hours,7 days,30 days and 90 days after treatment,Barthel index(BI),mortality and side effects before treatment and 90days after treatment were all observed.Results Scoring of CSS 6 hours,24 hours 7 days,30 days and 90 days after treatment were 15.38,13.24,9.30,7.40,5.00 in intravenous thrombolysis group,and 20.65,18.78,14.90,13.00,11.95 in control group.High score of BI(95～100) at 90 days after treatment were 57% in intravenous thrombolysis group and 22% in control group.The efficacy rate and mortality rate were 76%,5% in intravenous thrombolysis group,and 30%,9% in control group.All the data showed there were significant differences in CSS and total effective rate between the two groups(P<0.01).Conclusion Early application of rt-PA intravenous thrombolysis is effective and safe for patients with acute cerebral infarction.