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北京地区rt-PA静脉溶栓治疗超早期脑梗死患者临床分析
引用本文:孙玉衡,冯立群,张微微,王伊龙.北京地区rt-PA静脉溶栓治疗超早期脑梗死患者临床分析[J].中国卒中杂志,2006,1(6):389-393.
作者姓名:孙玉衡  冯立群  张微微  王伊龙
作者单位:1. 100000,北京市,北京大学第四临床医学院神经内科
2. 北京安贞医院神经内科
3. 北京军区总医院神经内科
4. 北京天坛医院神经内科
摘    要:目的分析北京地区12所医院202例超早期脑梗死患者经不同剂量重组组织型纤溶酶原激活剂(rt- PA)静脉溶栓治疗后的疗效及其不良事件,探讨使用rt-PA的最佳剂量及其安全性与可行性。方法287例发病6h以内的脑梗死患者,男201例,女86例,年龄38~80岁,平均64岁。所有患者均伴有偏瘫,头颅CT未见出血及责任梗死灶,无溶栓禁忌证。202例接受rt-PA治疗,分为A组与B组,A组88例,给予rt-PA 0.9 mg/kg。B组114例,给予rt- PA0.6~0.8 mg/kg。C组(对照组)85例患者给予低分子右旋糖酐、复方丹参等治疗。分别比较治疗前与治疗后11d、21 d、90 d的美国国立卫生院神经功能缺损评分(NIHSS)、Barthel指数,并进行疗效评定。结果A组、B组分别与C组90 d的NIHSS评分、Barthel指数相比有显著差异。A组、B组及C组的基本痊愈及显著改善率分别为69%、77%及40%.A组、B组分别与C组脑出血的发生率为7.96%、4.38%及0%。症状性出血(4.55%、2.63%及0%),非症状性出血(2.63%、1.75%及0%)。结论超早期脑梗死静脉应用rt-PA溶栓治疗是安全有效的。不同剂量的rt-PA均减轻了脑梗死的致残率,但两组间无明显差异。中国人rt-PA溶栓治疗最佳剂量尚需要进一步进行大样本的前瞻性、多中心、随机对照研究.

关 键 词:重组组织纤维蛋白溶酶原激活剂  脑梗死  静脉溶栓
文章编号:1673-5765(2006)06-0389-05
修稿时间:2006年6月10日

Clinical Analysis of Recombinant Tissue Plasminogen Activator on the Treatment of Ultra-acute Cerebral Infarction in Beijing Area
SUN Yu-heng,FENG Li-qun,ZHANG Wei-wei,WANG Yi-long.Clinical Analysis of Recombinant Tissue Plasminogen Activator on the Treatment of Ultra-acute Cerebral Infarction in Beijing Area[J].Chinese Journal of Stroke,2006,1(6):389-393.
Authors:SUN Yu-heng  FENG Li-qun  ZHANG Wei-wei  WANG Yi-long
Abstract:Objective To analyze and summarize the safety and feasibility of recombinant tissue plasminogen activator (rt-PA) therapy with different dosage for ultra-acute cerebral infarction in 12 hospitals in Beijing area.And to find the most suitable dosage and to observe its adverse effects.Methods There were 287 patients (male201,female 86,38 to 80 years-old) within 6 hours of ultra-acute cerebral infarction.All the patients suffered from paralysis.The head CT of all the patients didn't show cerebral hemorrhage and new responsible infarction.And they didn't have any contraindication.Totally 202 patients received rt-PA treatment.They were divided into group A (88 cases) administered with rt-PA in a dose of 0.9 mg/ kg body weight and group B (114 cases) in a dose of 0.6-0.8 mg/kg body weight,rt-PA wasn't administered in the C (control) group (85 cases).A contrast of the NIHSS,Barthel Index (BI) was made before treatment and on the I st day,21st day,90th day.Results There was a significant difference among group A,group B and group C by the NIHSS,BI of 90th day.Sixty- one cases(69%) in group A and 88 cases(77%) in group B got almost recovered and obviously improved,while in group C there were only 34 cases(40%).The incidence rate of intracerebral hemorrhage was 7.96%,4.38 % and 0% respectively with symptomatic hemorrohage 4.55%,2.63% and 0% respectively.Conclusion The findings suggest that for the patients with ultra-acute cerebral infarction,intravenous thrombolysis with rt-PA is effective and safe.Diffecent dosage of rt-PA can both decrease the incidence of disability but it has no significant difference between the two dosage treatment.To investigate whether 0.6-0.8 mg/kg is the most suitable dosage of rt-PA for Chinese individuals in the treatment of ultra-acute cerebral infarction,prospective,multi-center and randomized-controlled trials of large data should be done.
Keywords:recombinant tissue-type plasminogen activator  cerebral infarction  intravenous thrombolytic therapy
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