重组组织型纤溶酶激活剂治疗急性脑梗死的临床研究

【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】急性脑梗死84例（发病时间〈6h）随机分为溶栓组（＂-34）和对照组（n=50）。溶栓组用rt—PA0．9mg／kg，溶栓12h后给予皮下注射低分子肝素钙0．4mL，2次／d，连续应用7d；对照组不使用rt—PA，其他治疗均与溶栓组相同。于治疗前后评定临床神经功能缺损程度评分（NIHSS）和Barthel指数，监测纤维蛋白原（Fib）水平以及颅内出血情况。【结果】溶栓组治疗后24h、7d、1个月及3个月的NIHSs评分均明显低于对照组（P〈0．05）；两组患者治疗7d后Barthel指数开始明显升高，治疗后7d、1个月及3个月溶栓组的Bar—theI指数均明显高于对照组（P〈0．05）；溶栓组显效率和总有效率均高于对照组（x2=8．57，9．84；P〈0．01）；两组Fib水平治疗后12h明显降低（P〈O．05），治疗后48h及72h两组Fib水平恢复至治疗前水平，两组间差异无显著性。两组死亡率及出血并发症发生率差异无显著性。【结论】急性脑梗死早期应用rt—PA静脉溶栓治疗安全有效。

Clinical Study of Recombinant Tissue Plasminogen Activator for the Treatment of Acute Cerebral Infarction

Objective] To explore the efficacy and safety of recombinant tissue plasminogen activator （rt- PA） intravenous thrombolysis therapy in early acute cerebral infarction （ACI）. Methods] Eighty four cases of ACI （incidence time G6 h） were randomly divided into thrombolysis group （ n = 34） and the control group （ n=50）. Thrombolysis group received rt PA 0. 9mg/kg, after 12h then received subcutaneous injection of low-molecular-weight heparin calcium 0.4ml bid for 7d. Except rt-PA, the control group received the above regimen. The NIHSS score, Barthel index, fibrinogen （Fib） level and intracranial hemorrhage situation in both groups were assessed before and after treatment, respectively. Results]After 24h, 7d, 1-month and 3- month, NIHSS score of patients in thrombolysis group was significantly lower than that in the control group （ P〈0.05）. Barthel index of two groups increased significantly after treatment 7d, and 7 days, 1-month and 3- month after treatment. Barthel index of thrombolysis group was significantly higher （ P 〈0.05） than that in the control group. The significant and total efficiency of thrombolysis group was higher than that of the control group （x2 =8.57, 9.84; P G0.01）. After 12h treatment, Fib level in both group decreased significantly （ P 〈0. 05）. After 48h and 72h treatment, Fib level returned to the level before treatment, but there was no sig- nificant difference between two groups. The difference in mortality and the incidence of bleeding complications between two groups was not significant. Conclusion]The early application of rt-PA intravenous thrombolysis for treating ACI patients is safe and effective.