轻症脑梗死rt-PA静脉溶栓的疗效及安全性观察

目的观察静脉注射阿替普酶(rt-PA)治疗急性轻症脑梗死患者的临床疗效及安全性。方法采用前瞻性研究方法,收集110例起病4.5h内、美国国立卫生研究院卒中量表(NIHSS)评分≤7分的轻症脑梗死患者的临床资料,其中试验组53例接受rt-PA静脉溶栓治疗,对照组57例接受常规治疗,通过分析患者基线资料及溶栓后24h、7dNIHSS和改良Rankin量表(mRS)评分、90d的mRS评分及治疗期间的颅内出血转化、其他部位出血、药物过敏、死亡等不良事件,评估试验治疗方案的有效性和安全性。结果在2组患者人口学特征、影像学特点、实验室检查、神经功能评分等基线资料中,既往脑出血史对照组显著高于试验组,差异有统计学意义(P0.05),而其他基线资料2组间差异无统计学意义(P0.05)。24h后试验组NIHSS、mRS评分均显著低于对照组,差异有统计学意义(P0.05);7d后试验组NIHSS、mRS评分同样低于对照组,差异有统计学意义(P0.05);90d时试验组mRS为0分、0~1分的比例显著高于对照组,差异有统计学意义(P0.05)。安全性方面2组中轻型出血转化各1例,无过敏及死亡病例,差异无统计学意义(P0.05),但颅外少量局限性出血等不良反应,试验组显著高于对照组,差异有统计学意义(P0.05)。结论轻症脑梗死接受rt-PA静脉溶栓有效和相对安全。

Observation of safety and effectiveness of intravenous thrombolysis with rt-PA in patients with mild acute cer-ebral infarction

Objective To observe the safety and effectiveness of intravenous thrombolysis with alteplase (rt-PA)in pa‐tients with mild acute cerebral infarction .Methods This was a prospective study .We selected clinical data originating from 110 cases who met the inclusion criteria containing onset within 4.5 h and NIHSS scores ≤7 points .53 cases in observation group accepted intravenous thrombolysis with rt-PA and 53 cases in control group accepted conventional treatment .The data in base‐line ,NIHSS and mRS scores 24 h and 7 days after thrombolysis ,mRS scores 90 days after thrombolysis and adverse events such as cerebral hemorrhage transformation ,bleeding in other places ,drug allergy and death were analyzed to evaluate the safe‐ty and effectiveness .Results Among the data in baseline including demographic charateristics ,imaging features ,laboratory in‐dices ,neurological function scores and so on ,except for history of cerebral hemorrhage which was significantly higher in control group compared with observation group(P<0.05) ,other data showed no differences between two groups(P>0.05) .In addi‐tion ,both 24 h and 7 d after thrombolysis ,the NIHSS and mRS scores in the observation group were obviously lower than those in the control group(P<0.05) .On the 90th day the observation group disclosed higher proportion in getting a mRS score of zero or one(P<0.05) .One case had cerebral hemorrhage transformation and no one had drug allergy and death in each group ,with no statistical differences(P<0.05) ,but bit limited bleeding outside cranium which was higher in the observation group showed significant difference(P<0.05) .Conclusion Intravenous thrombolysis with rt-PA in the treatment of mild a‐cute cerebral infarction is effective and relative safe .