急性脑梗死伴肾功能不全患者静脉溶栓疗效观察

目的 观察急性脑梗死伴肾功能不全患者静脉溶栓治疗的有效性和安全性.方法 回顾性分析63例重组人组织纤维蛋白溶酶原激活剂（rt-PA）静脉溶栓治疗急性脑梗死患者,比较肾功能不全组和肾功能正常组溶栓后24小时NIHSS评分和出院时mRS评分、住院天数及出血转化情况.结果 两组患者性别、高血压、糖尿病、房颤患病率及起病时血糖、血压、总胆固醇、凝血酶原时间等基线资料比较,差异均无统计学意义（P＞0.05）.肾功能不全组存在年龄高,血红蛋白含量低,血小板计数少,尿酸高以及既往脑卒中史多等危险因素,差异有统计学意义（P＜0.05）.两组患者溶栓后24小时NIHSS评分和出院时mRS评分均有显著改善,差异有统计学意义（P＜0.05）;但溶栓前NIHSS评分、溶栓前mRS评分,溶栓后24小时NIHSS评分和出院时mRS评分、住院天数及出血例数比较两组间差异均无统计学意义（P＞0.05）.结论 急性脑梗死伴肾功能不全患者rt-PA静脉溶栓治疗可同样获益,且出血风险无显著增加.

Observation on the Efficacy of Intravenous Thrombolytic Therapy in Acute Cerebral Infarction Patients with Renal Impairment

Objective To examine the efficacy and safety of intravenous thrombolytic therapy in acute cerebral infarction patients with renal impairment.Methods Retrospective analysis was made on 63 stroke patients who received intravenous thrombolytic therapy with rt-PA,and compared the NIHSS score at 24 hours,mRS score at discharge,hospitalization days and incidence of ICH between the group of patients with renal impairment and the group with normal ones respectively.Results At the baseline level,there were no significant difference in the gender,prevalence of hypertension,diabetes and atrial fibrillation,presenting blood glucose,blood pressure,total cholesterol and prothrombin time at onset between the two groups （P ＞ 0.05）.Patients with renal impairment were older,with lower hemoglobin,less blood platelet,higher uric acid,and more commonly had prior ischemic stroke history than patients without renal dysfunction,and the difference was statistically significant （P ＜ 0.05）.In both groups,the NIHSS score at 24 hours after thrombolysis and mRS score at discharge were significantly improved（P ＜ 0.05）.There was no significant difference in NIHSS score and mRS score before thrombolysis between groups （P ＞ 0.05）.NIHSS score at 24 hours,mRS score at discharge,hospitalization days and incidence of ICH also showed no significant difference （P ＞ 0.05）.Conclusions Acute cerebral infarction patients with renal impaiment receiving rt-PA therapy for acute cerebral infarction were found no increased hemorrhagic complications,and obtained equal efficacy compared with patients with normal renal function after the rt-PA therapy.