重组组织型纤溶酶原激活剂超早期静脉溶栓治疗急性椎-基底动脉梗死的疗效观察

目的探讨重组组织型纤溶酶原激活剂（rt-PA）超早期静脉溶栓治疗急性椎-基底动脉梗死的疗效和安全性。方法回顾性分析60例急性椎-基底动脉梗死患者的治疗效果。治疗组21例,发病6h内给予rt-PA静脉溶栓治疗 对照组39例,给予除溶栓外的积极抢救治疗。比较治疗后24h、14d和90d存活率以及美国国立卫生研究院神经功能缺损评分（NIHSS）,评价治疗后14d、90d的Barthel指数（BI）及90d综合生活能力（改良Rankin评分,mRS）,并记录出血并发症的发生率。结果治疗组和对照组90d存活率分别为57.14%和23.08%（P〈0.05）。治疗组溶栓后24h、14d、90d较溶栓前NIHSS评分均有明显改善（P〈0.05或0.01） 对照组治疗后14d、90d较治疗前NIHSS评分均有明显改善（P〈0.05或0.01） 治疗组治疗24h、90dNIHSS评分改善优于对照组（P〈0.05）。治疗组溶栓后14d、90dBI评分分别为（70.00±29.05）分和（92.50±39.57）分,对照组治疗后14d、90dBI评分分别为（49.09±27.37）分和（60.23±25.75）分,治疗组改善优于对照组（P〈0.05） 两组治疗90d后mRS评分分别为（1.00±0.95）分和（2.63±1.77）分（P〈0.05）。治疗组和对照组出血并发症发生率分别为23.81%和10.26%（P〉0.05）,无症状性颅内出血及致死病例。结论椎-基底动脉梗死患者发病6h内应用rt-PA静脉溶栓治疗是有效和安全的。

Therapeutic effects of thrombolysis with rt-PA intravenous in patients with ultra-acute vertebrobasilar artery infarction

Objective To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） in patients with ultra-acute vertebrobasilar artery infarction. Methods Therapeutic effects of 60 patients with ultra-acute vertebrobasilar artery infarction were retrospectively analyzed. The treatment group （21 cases） received intravenous rt-PA within 6 hours from symptom onset,while the control group （39 cases） received conventional treatment except thrombolysis. The survival rate and the assessment of nerve function by National Institute of Health Stroke Scale （NIHSS） score were recorded before treatment,and in 24 hours,on the 14th and 90th days after treatment. Barthel Index （BI） was made on 14th and 90th days after treatment. Modified Rankin＇s Score （mRS） was also assessed on the 90th day,and the incidence of bleeding complications were monitored.Results The survival rates on the 90th day were 57.14% and 23.08% in the treatment group and control group,respectively （P0.05）. In the treatment group,the NIHSS scores in 24 hours,on the 14th and 90th days were improved after treatment （P0.05 or 0.01）. In the control group,the NIHSS scores on the 14th and 90th days were improved after treatment （P0.05 or 0.01）. The NIHSS scores in 24 hours and on the 90th day were much improved in the treatment group than the controls （P0.05）. The BI scores on the 14th and 90th days were much improved in the treatment group than the controls （P0.05）,with （70.00±29.05） and （92.50±39.57） in the treatment group and （49.09±27.37） and （60.23±25.75） in the control group,respectively. In the treatment group and the control group,the mRS on the 90th day were （1.00±0.95） and （2.63±1.77）,respectively （P0.05）,and the incidence of bleeding com-plications were 23.8% and 10.26% （P0.05）. There was no fatal symptomatic intracranial hemorrhage. Conclusion Intravenous thrombolysis with rt-PA is effective and safe within 6 hours from symptom