阿替普酶静脉溶栓治疗急性脑梗死的疗效及安全性

目的研究重组组织型纤溶酶原激活物(rt-PA)静脉给药溶栓治疗急性脑梗死的临床效果。方法回顾性分析发病在4.5h内,具有溶栓指征的急性脑梗死患者105例,其中对照组56例仅给予抗血小板聚集、调脂稳定斑块等常规治疗方案,观察组49例给予rt-PA静脉溶栓治疗,24h后若无明显出血,开始给予脑梗死常规治疗。比较2组治疗后90d美国国立卫生院卒中量表(NIHSS)评分、Barthel指数(BI)评分及改良Rankin量表(mRS)评分改善情况,以评价rt-PA治疗急性脑梗死临床疗效。结果 2组治疗前NIHSS评分差异无统计学意义(P0.05),观察组溶栓后2h、24h、7d时NIHSS评分显著低于对照组(P0.05);观察组90d时mRS评分显示预后良好的患者较对照组明显增多,2组比较差异有统计学意义(P0.05);与对照组比较,观察组90d时Barthel指数评分明显升高(P0.05)。虽然观察组总体出血事件较对照组增高(P0.05);但2组症状性脑出血比较差异无统计学意义(P0.05)。结论发病4.5h以内,静脉给予rt-PA溶栓治疗急性脑梗死具有显著的临床疗效,且安全性较高,值得临床推广应用。

Analysis of the effect and safety of intravenous thrombolysis with alteplase in patients with acute cerebral infarc-tion

Objective To explore the effect and safety of intravenous thrombolysis with Alteplase in patients with acute cer-ebral infarction(ACI).Methods The data of 105 patients with ACI within 4.5 hours were analyzed.The 56 patients from control group underwent routine therapy for ACI such as antiplatelet agents and Lipid-lowering agents,while the 49 patients from observa-tion group accepted intravenous thrombolysis with Alteplase before the onset of the routine therapy which will been given if there was no cerebral hemorrhage 24 hours after the intravenous thrombolysis therapy.The clinic effect of the Alteplase was assessed by the National Institutes of Health Stroke Scale(NIHSS)score,Barthel index(BI),Modified Rankin Scale(mRS)score of the two groups 90 days after the onset of treatment.The safety of Alteplase was assessed by comparing the incidence of bleeding events be-tween the two groups.Results NIHSS score:There was no statistically significant difference between the two groups in compari-son of NIHSS score before onset of treatment(P >0.05).The NIHSS score of patients from observation group was significantly lower than that from control group in 2 hours,24 hours and 7 days after onset of treatment(P <0.05).mRS score:The number of patients with good outcome is larger in observation group than in control group 90 days after treatment (P <0.05).BI score:The BI score of patients from observation group is higher than that of control group 90 days after treatment(P <0.05 ).Bleeding E-vents:Although the overall bleeding events in the observation group were higher than that in the control group (P <0.05),there was no statistically significant difference in comparison of symptomatic intracerebral hemorrhage between the two groups (P >0.05).Conclusion Within 4.5 hours of onset of ACI,intravenous thrombolysis with Alteplase has good clinical effect and is safe. So it is recommended to be used in patients with ACI.