高龄脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的有效性和安全性

目的探讨高龄脑梗死患者应用重组组织型纤溶酶原激活剂(rt -PA)静脉溶栓治疗的有效性和安全性。方法选择急性脑梗死患者196例,根据患者年龄分为<80岁组141例和≥80岁组55例,发病<4.5 h的患者给予rt-PA静脉溶栓治疗,比较2组患者溶栓前、溶栓后14 d的美国国立卫生研究院卒中量表(NIHSS)评分,观察溶栓后颅内出血(ICH)和症状性颅内出血(sICH)的发生率。90 d随访时,采用改良Rankin's评分评定临床结局。结果 2组溶栓后14 d的NIHSS评分都较溶栓前显著降低(P<0.01),<80岁组较≥80岁组NIHSS评分降低更明显(P<0.01)。≥80岁组的病死率显著高于<80岁组(P<0.05);<80岁组和≥80岁组预后良好的比例分别为57.5%和45.5%(P>0.05),ICH发生率分别为16.3%和21.8%,sICH发生率分别为6.4%和14.5%(P>0.05)。结论高龄脑梗死患者应用rt-PA静脉溶栓和年龄<80岁者同样是安全有效的。

Efficiency and safety of intravenous rt-PA thrombolysis therapy for advance-aged patients with cerebral stroke

Objective To study the efficiency and safety of intravenous rt-PA thrombolysis therapy for advance-aged patients with cerebral stroke.Methods One hundred and ninety-six patients with acute cerebral stroke were divided into <80 years old group(n= 141) and≥80 years old group(n = 55).The patients received intravenous rt-PA thrombolysis therapy within 4.5 hours after cerebral stroke onset.Acute cerebral stroke scores on the National Institute of Health Stroke Scale(NIHSS) were compared beetween the two groups before and after intravenous rt-PA thrombolysis therapy.The incidence of intracerebral hemorrage(ICH) and symptomatic ICH (sICH) was recorded.The patients were followed up for 90 days and their clinical outcomes were assessed according to the modified Rankin scale(mRS).Results The acute cerebral stroke scores on NIHSS were significantly higher in <80 years old group than in≥80 years old group on day 14 after thrombolysis therapy(P<0.01).The mortality was significantly higher in≥80 years old group than in <80 years old group(P<0.05).The proportion of 0-2 acute cerebral stroke scores on the mRS was 57.5%and 45.5%,respectively,in <80 years old group and≥80 years old group(P>0.05).No significant difference was found in the incidence of ICH and sICH between <80 years old group and≥80 years old group(16.3%vs 21.8%,6.4%vs 14.5%,P> 0.05).Conclusion It is effective and safe for advance-aged and <80 years old patients to receive rt-PA thrombolysis therapy.