不同年龄急性缺血性脑卒中患者阿替普酶静脉溶栓的风险获益分析

目的： 探讨不同年龄段急性缺血性脑卒中患者静脉溶栓治疗的安全性和有效性。方法： 回顾性收集扬州市江都人民医院2017年7月至2020年3月神经内科收治的静脉溶栓患者共126例作为研究对象。按照患者年龄分为4组（<60岁，60~69岁，70~79岁，≥ 80岁），患者发病时间均小于4.5 h，采用阿替普酶静脉溶栓治疗，并通过χ²检验比较患者溶栓前的一般资料，根据溶栓前后美国国立卫生研究院卒中量表（NIH stroke scale，NIHSS）评分改善情况进行有效性分析，患者出血情况及其他不良反应进行安全性分析。结果： （1）年龄≥ 80岁组患者房颤比例较高，Toast分型中（cardio embolism，CE）型比例较高，与其他组有显著差异。其余基线资料无统计学差异。（2）4组患者NIHSS评分降低无显著差异，24 h恢复良好率、NIHSS评分改善情况无显著差异；（3）4组患者出血发生率、非直接不良反应发生率、出院死亡率无显著差异；年龄≥ 80岁组患者颅内出血风险显著增加。结论： 对于发病4.5 h的高龄（≥ 80岁）急性缺血性卒中患者，静脉溶栓治疗获益与<80岁患者相同，出血风险也并未增加，但是对于年龄超过80岁且伴有房颤患者，NIHSS评分较高时，选择是否溶栓要慎重。

Analysis of risk and benefit of alteplase intravenous thrombolysis in patients with acute ischemic stroke of different ages

OBJECTIVE To investigate the safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke at different ages.METHODS A total of 126 patients with intravenous thrombolysis admitted to the Department of Neurology of Yangzhou city Jiangdu People's Hospital from July 2017 to March 2020 were retrospectively collected. According to the age of the patients, the patients were divided into groups of age (age<60, 60-69, 70-79, ≥ 80 years old). The onset time of the four groups was less than 4.5 hours. The risk factors before thrombolysis were determined by χ² test. The patients were improved according to NIHSS score before and after thrombolysis. Effectiveness analysis was performed, and safety analysis was carried out in four groups of patients with hemorrhage and other types.RESULTS (1)The proportion of patients with atrial fibrillation was higher in patients older than 80 years old than that in patients younger than 80 years old. There was statistical significance between the four groups in TOAST classification. The proportion of CE type was higher in TOAST classification at the age of ≥ 80 years old. There was no statistical difference in other baseline data. (2) There was no significant difference in NIHSS score reduction, 24-hour recovery rate and NIHSS score improvement among the four groups; (3)There was no significant difference in bleeding rate, indirect adverse reaction rate and discharge mortality among the four groups.CONCLUSION For the elderly (≥ 80 years old) patients with acute ischemic stroke, the benefit of intravenous thrombolysis is the same as that of the patients below 80 years old, and the risk of bleeding has not increased. However, for the patients over 80 years old with atrial fibrillation, when NIHSS score is high, the thrombolysis should be used with caution.