rt-PA静脉溶栓治疗急性脑梗死的临床研究

目的探讨重组组织型纤溶酶原激活物（rt-PA）静脉溶栓治疗急性脑梗死的临床疗效。方法 69例发病在4.5小时内具有溶栓指征的急性脑梗死患者,其中观察组37例行rt-PA静脉溶栓,对照组32例行常规抗血小板治疗。以美国国立卫生院卒中量表（NIHSS）评分评定溶栓后临床疗效,以Barthel指数（BI）评分及改良Rankin量表（mRS）评分判断治疗后90d生活质量及预后。结果观察组治疗后2h、24h、7d NIHSS评分显著低于对照组（9.23±3.51）vs（11.32±1.12）,（6.72±2.31）vs（9.24±2.53）,（4.23±2.12）vs（7.34±1.43）],差异有统计学意义（P〈0.05）;治疗后90天BI评分观察组显著高于对照组（78.56±3.51）vs（61.30±4.13）],差异有统计学意义（P〈0.05）;治疗后90天mRS评分疗效良好率观察组显著高于对照组67.56%（25/37）vs 34.38%（11/32）],差异有统计学意义（P〈0.01）。观察组24h脑出血率及死亡率高于对照组16.21%（6/37）vs 9.37%（3/32）],但差异无统计学意义（P〉0.05）。结论时间窗内rt-PA静脉溶栓治疗急性脑梗死近、远期疗效均较常规抗血小板治疗显著。

Clinical Study of Rt_PA Intravenous Thrombolytic Therapy on Acute Ischemic Stroke

Objective To investigate the clinical effects of rt-PA intravenous thrombolysis therapy on acute ischemic stroke.Methods Since January to December in 2010 ,The Neurology Department of Huzhou center hospital received and cured 69 patients in 4.5 hours after the onset of acute ischemic stroke who have thrombolysis indication and sign the treatment consent form.The 37 cases in treat-ment group received rt-PA intravenous thrombolysis therapy ,while 32 cases in control group received routine antiplatelet therapy.The United States national institutes of health stroke scale （NIHSS ） was used to evaluate the clinical effects after thrombolysis.Barthel index （BI） and Modified Rankin scale （mRS） were used to judge quality of life and prognosis after treatment for 90 days. Results NHISS scores of treatment group were significantly lower than the control group after treatment for 2h ,24h and 7d （9.23 ± 3.51） versus （11.32 ± 1.12） ,（6.72 ± 2.31） versus （9.24 ± 2.53） ,（4.23 ± 2.12） versus （7.34 ± 1.43）] ,there were statistical significance differences （ P〈0.05 ）;BI score of treatment group was significantly higher than control group after treatment for 90 days （78.56 ± 3.51 ） versus （61.30 ± 4.13 ）] ,there was a statistical significance difference （ P〈0.05 ）;Good Effect rate of mRS score of treatment group was significantly higher than the control group after treatment for 90 days 67.56% （25/37） versus 34.38% （11/32）] ,there was a statistical significance difference （ P〈0.05）.Cerebral hemorrhage rate after 24h in treatment group was higher than the control group 16.21% （6/37 ） versus 9.37% （3/32 ）] ,there were no statistical significance （ P〉0.05 ）.Conclusions The short and long term curative effects of rt-PA intravenous thrombolysis treatment within the time window on acute cerebral infarction are significantly better than conventional antiplatelet therapy ,but the risk of hemorrhage is higher.