重组组织型纤溶酶原激活剂联合尿激酶治疗急性脑梗死的临床观察

目的观察低剂量重组组织型纤溶酶原激活剂(rt-PA)联合尿激酶静脉溶栓治疗急性脑梗死的远期疗效和安全性。方法选择急性脑梗死患者161例,分为4组:联合溶栓组44例,给予静脉rt-PA尿激酶;rt-PA组37例,尿激酶组32例,对照组48例。观察治疗前及治疗后90 d美国国立卫生研究所卒中量表(NIHSS)评分,同时观察再梗死率、脑出血率及病死率。结果与治疗前比较,4组治疗后90 d NIHSS评分差异均有统计学意义(P<0.01)。3个溶栓组与对照组在90 d有效率及疗效满意率差异均有统计学意义(P<0.01);3个溶栓组90 d有效率及疗效满意率差异无统计学意义(P>0.05)。联合溶栓组与rt-PA组和尿激酶组脑出血率比较差异均有统计学意义(2.3%υs 18.9%υs 18.7%,P<0.05)。结论 rt-PA联合尿激酶治疗急性脑梗死远期疗效和单用rt-PA、单用尿激酶相当,但脑出血率降低,因此该治疗方法是安全有效的,值得推广应用。

Combined thrombolytic therapy with low-dose recombinant tissue plasminogen activator and urokinase for ACI

Oobjective To observe the long-term effect and safety of combined thrombolytic therapy with low-dose recombinant tissue plasminogen activator(rt-PA) and urokinase(UK) for acute cerebral infarction(ACI).Methods One hundred and sixty-one ACI patients were randomly divided into combined thrombolysis group(n = 44 ),rt-PA group(n = 37),UK group(n = 32),and control group in = 48).Their NIHSS scores and rates of recurrent infarction,hemorrhage and death were observed before and 90 days after treatment.Results The effect of combined thrombolytic therapy for ACI was significantly better 90 days after treatment than before treatment (P<0.01).However,no significant difference was observed in its effective and satisfactory rates for ACI between 3 thrombolysis groups and control group 90 days after treatment(P>0.05).The incidence of intra cerebral hemorrhage was significantly lower in combined thrombolysis group than in rt-PA group and UK group(2.3%vs 18.9%and 18.7%,P<0.05).Conclusion The long-term effect of combined thrombolytic therapy is similar to that of rt-PA therapy or urokinase therapy for ACI with a low incidence of cerebral hemorrhage,it is thus a safe and effective modality for ACI and should be popularized.