TOAST分型rt-PA静脉溶栓治疗超早期脑梗死的效果研究

目的 评价超早期脑梗死TOAST分型rt-PA静脉溶栓治疗的有效性和安全性。方法 选取静海区医院收治的急性脑梗死患者129例，将所有脑梗死患者根据TOAST分型划分为LAA组、CE组、SAO组及SOE＋SUE组共四组，所选患者均为发病时间在4.5 h内，行规范性rt-PA静脉溶栓治疗，对比分析其临床效果和治疗的不良反应。结果 LAA组、CE组、SAO组、SOE＋SUE组溶栓治疗前后NIHSS评分下降，差异有统计学意义（P＜0.05）；溶栓治疗后各组NIHSS评分比较，SAO组低于LAA组、CE组、SOE＋SUE组，差异有统计学意义（P＜0.05）；CE组不良反应发生率高于LAA组、SAO组、SOE＋SUE组，差异有统计学意义（P＜0.05）。结论 超早期脑梗死4.5 h内行rt-PA静脉溶栓治疗不同TOAST分型脑梗死患者均可获益，且SAO型效果最佳；针对于CE患者应注意病情变化，降低其出血发生率。

Study on the Effect of Intravenous Thrombolytic Therapy with TOAST Type rt-PA in the Treatment of Super Early Cerebral Infarction

Abstract:Objective To evaluate the efficacy and safety of TOAST classification rt-PA intravenous thrombolytic therapy for super early cerebral infarction.Methods 129 patients with acute cerebral infarction treated in Jinghai District Hospital were divided into four groups according to TOAST classification:LAA group,CE group,SAO group and SOE+SUE group.All the patients were treated with rt-PA intravenous thrombolytic therapy within 4.5 h.The clinical effect and adverse reaction of the treatment were compared and analyzed.Results The NIHSS scores of LAA group,CE group,SAO group,SOE+SUE group before and after thrombolytic therapy were significantly decreased,the difference was statistically significant(P<0.05);After thrombolytic treatment,the scores of NIHSS in group SAO were lower than that in group LAA,group CE and SOE+SUE group,the difference was statistically significant(P<0.05),and the incidence of adverse reactions in group CE was higher than that in group LAA,SAO and SOE+SUE group,and the difference was statistically significant(P<0.05).Conclusion The 4.5h rt-PA intravenous thrombolytic therapy in the ultra early cerebral infarction can benefit from the different TOAST type cerebral infarction patients,and the SAO type effect is the best.For the patients with CE,we should pay attention to the change of the disease and reduce the incidence of bleeding.