不同时间窗重组组织型纤溶酶原激活剂静脉溶栓治疗椎-基底动脉系统脑梗死的疗效

目的探讨不同时间窗重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗椎-基底动脉系统脑梗死的疗效。方法对26例经多模式MRI证实的椎-基底动脉系统脑梗死患者行rt-PA静脉溶栓治疗,治疗时间窗<4.5 h组和4.5～9 h组各13例。患者在治疗前及治疗后24 h、14 d、90 d进行美国国立卫生研究院卒中量表(NIHSS)评分,90 d时行Bathel指数(BI)、改良Rankin量表(mRs)评分,比较两组的疗效;观察溶栓后有无脑出血发生。结果 <4.5 h组与4.5～9 h组各时间点NIHSS、BI及mRs评分差异无统计学意义。<4.5 h组与4.5～9 h组各有1例非症状性脑出血。90 d时,<4.5 h组mRS评分预后良好7例(53.85%);4.5～9 h组6例(46.15%),两组预后良好率的差异无统计学意义。结论椎-基底动脉系统脑梗死静脉rt-PA溶栓治疗4.5 h时间窗和适当延长治疗时间窗均安全有效。

Effects of intravenous thrombolytic therapy with recombinant tissue plasminogen activator for vertebrobasilar system cerebral infarction within different time windows

Objective To investigate the effects of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA) for vertebrobasilar system cerebral infarction within different time windows.Methods Twenty-six vertebrobasilar system cerebral infarction patients who confirmed by multi-modality MRI were treated with rt-PA intravenous thrombolytic therapy.The time window <4.5 h group and 4.5-9 h group were 13 cases respectively.The national institutes of health stroke scale(NIHSS) was assessed at pre-therapy and 24 h,14 d,90 d post therapy.Barthel Index(BI) and modified Rankin Scale(mRS) were assessed at 90 d after therapy.The efficacy was compared between the 2 groups.Whether no cerebral hemorrhage happen post-therapy was observed.Results The scores of NHISS,BI and mRs at each time point between <4.5 h group and 4.5-9 h group were no statistical difference.The 1 case in each group was happend with non-symptomatic intracerebral hemorrhage.At 90 d after therapy,mRs score of good prognosis in <4.5 h group was 7 cases(53.85%),and in 4.5-9 h group was 6 cases(46.15%).The rate of good prognosis in the 2 groups was no statistical difference.Conclusion The time window of intravenous thrombolytic therapy with rt-PA for vertebrobasilar system cerebral infarction within 4.5 h or prolonging properly is effective and safe.