艾通立早期静脉溶栓治疗急性脑梗死--附100例病例分析

目的：评价重组组织型纤溶酶原激活剂(rt-PA)艾通立对急性脑梗死早期静脉溶栓治疗的疗效及安全性，同时探讨国人应用rt-PA治疗的最佳剂量。方法：凡符合入选标准的患者随机分为A、B、C 3组，A组为rt-PA0．9mg／kg，B组为rt-PA 0．7mg／kg，C组作为对照组不用rt-PA。溶栓两组先将总量中的8mg静脉快速推入，剩余量在1h内用静脉泵输入，总量均不超过90mg。观察3组治疗后24h、90d神经功能缺损评分，及90d日常生活能力指数(Barthel)，同时观察3组治疗后30d脑出血率及病死率。结果：A组溶栓后24h和90d治愈及显效率为41．18％和76．47％，90d Barthel指数为95～100分者占58．82％，30d脑出血率为8．82％，病死率为5．88％。B组溶栓后24h和90d治愈及显效率为39．39％和69．70％，90d Barthel指数为95～100分者占54．55％，30d脑出血率为9．09％，病死率为9．09％。C组治疗后24h和90d治愈及显效率为21．21％和30．30％，90d Barthel指数为95～100分者占21．21％，30d病死率为9．09％。90d溶栓组显效率(73．13％)明显高于对照组(30．30％，P=0．0017)，严重致残率分别为13．43％和24．24％。结论：急性脑梗死静脉应用rt-PA溶栓治疗是安全有效的，国外0．9mg／kg的剂量也适用于国人。

Early intravenous thrombolysis with recombinant tissue plasminogen activator for acute cerebral infarction

Objective: To evaluate the efficacy and safety of recombinant tissue plasminogen activator (rtPA) and to explore the most suitable dosage of rt PA in the early treatment of the Chinese patients with acute cerebral infarc tion(ACI). Methods: The patients who suited for the standard were divided into three groups. Group A received rtPA at 0 9 mg/kg, group B received rtPA at 0 7 mg/kg, and group C did not receive any thrombolytic therapy. In throm bolytic groups, rtPA at 8 mg was injected intravenously in a bolus at first and th en the rest was given over 60 minutes. The maximal dosage was 90 mg. The Chinese stroke scale (CSS) and Barthel Index (BI) were used to evaluate the recovery of neurological functions after rtPA treatment for 24 hours and 90 days. The hemorrhagic rate and 30 days mortality rate were also analysed. Results: In group A the CSS significant effective rate was 41 18 percent at 24 hours and 76 47 percent at 90 days after thrombolysis. At 90 days BI significant effective rate was 58 82 perc ent. At 30 days hemorrhagic rate was 8 82 percent and mortality rate was 5 88 perc ent. In group B, the CSS significant effective rate was 39 39 percent at 24 hours and 69 70 percent at 90 days. At 90 days, BI significant effectiv e rate was 54 55 percent, and at 30 days, hemorrhagic rate was 9 09 percent and mortality rate was 9 09 percent. In group C, the CSS significant e ffecti ve rate was 21 21 percent, at 24 hours and 30 30 percent at 90 days(P>0 05). At 90 days, BI was 21 21 percent the mortality rate was 9 09 percent. At 30 days the mortality rate w as no significant difference within three groups At 90 days, significant effective rate was 73 13 percent vs. 30 30 percent in thromblytic and cont rol groups (P=0 001 7). The significant disability rate was 13 43 perent vs. 24 24 percent. Conclusions: For Chinese individuals, with ACI, rtPA thrombolytsis was effect ive and safe.The dosage of 0 9 mg/kg for foreign people als o fitted for Chinese individuals.