尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中的疗效比较

【摘要】目的比较尿激酶动脉溶栓与重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗缺血性卒中的临床疗效。方法将100例缺血性卒中患者按照随机数字表法分为rt-PA静脉溶栓组和尿激酶动脉溶栓组，每组50例。观察并比较两组患者溶栓后血管再通率、病死率、并发症等。结果rt-PA静脉溶栓组溶栓后血管再通率明显高于尿激酶动脉溶栓组88．0％（44／50）比66．0％（33／50）]，并发症发生率明显低于尿激酶动脉溶栓组6．0％（3／50）比28．0％（14／50）]，差异有统计学意义（P〈0．05）。两组病死率比较差异无统计学意义（P〉0．05）。两组溶栓前美国国立卫生研究院卒中量表（NIHSS）评分比较差异无统计学意义（P〉0．05）；两组溶栓后1，3，10，30d的NIHSS评分较溶栓前明显降低，差异有统计学意义（P〈0．05）。两组不同时间NIHSS评分、溶栓后30d改良Rankin量表评分比较差异无统计学意义（P〉0．05）。结论rt-PA在缺血性卒中患者中的疗效明显优于尿激酶动脉溶栓治疗，不仅血管再通率高，且溶栓后并发症较少，安全有效，可作为缺血性卒中溶栓治疗的首选。

Comparative efficacy between arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator in treatment of ischemic stroke

Objective To compare the effect of arterial thombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA） in treatment of ischemic stroke. Methods One hundred patients with ischemic stroke were divided into intravenous thrombolysis （with rt-PA） group and arterial thrombolysis （with urokinase） group with 50 cases each by random digits table method. The thrombolytie recanalization rate, mortality rate and complications after treatment were observed and compared between two groups. Results The thrombolytic recanalization rate in intravenous thrombolysis （with rt-PA） group was higher than that in arterial thrombolysis （with urokinase） group 88.0% （44/50） vs. 6610% （33/50） ], the complication rate in intravenous thrombolysis （with rt-PA ） group was lower than that in arterial thrombolysis （with urokinase ） group 6.0% （ 3/50 ） vs. 28.0% （ 14/50 ） ], and there was significant difference （P 〈 0.05 ）. There was no significant difference in mortality between two groups （P 〉 0.05 ）.There was no significant difference in the National Institutes of Health Stroke Scale （NIHSS） scores before treatment between two groups （P 〉 0.05 ）. The NIHSS scores 1,3,10,30 d after treatment were lower than those before treatment in two groups, and there were significant differences （ P 〈 0.05 ）. There was no significant difference in NIHSS scores at different times and modified Rankin Scale 30 d after treatment between two groups （P 〉 0.05）. Conclusions The efficacy of rt-PA in ischemic stroke patients is significantly better than that of the arterial thrombolysis with urokinase, with higher recanalization rate and fewer complications. It is safe and effective, and can be as the first choice for the treatment of iscbemic stroke thrombolysis.