基层医院阿替普酶在脑梗死4.5h内静脉溶栓的回顾性分析

目的:观察阿替普酶(alteplase,rt-PA)在脑梗死4.5 h内溶栓的有效性及安全性,分析影响静脉溶栓预后因素。方法:回顾2007-2012年台州一院和温州一院96例4.5 h内静脉溶栓患者的资料,以NINDS研究和ECASS-3研究的资料作为本研究的对照。结果:对比经典试验,有统计学差异表明溶栓改善近期及长期预后,24 h改善率达52.1%,3个月预后良好的比例为46.9%,虽然增加了颅内出血风险,但以非症状性颅内出血为主,且不增加总体死亡率。良好预后与基线NIHSS评分≤12和24 h改善率相关。结论:只要严格掌握了溶栓的适应症和禁忌症,阿替普酶4.5 h内静脉溶栓是有效且安全的,特别是轻、中度(NIHSS≤12)卒中患者获益最大;可明显改善脑梗死患者的预后;不良预后与基线卒中病情严重相关。

A retrospective study on alteplase used for intravenous thrombolysis within 4.5 hours after cerebral infarction in primary hospitals

Objective: To observe the effectiveness and safety of alteplase used for thrombolysis within 4.5 h after cerebral infarction,and analyze factors influencing prognosis after intravenous thrombolytic therapy.Methods: The data of 96 patients with thrombolysis within 4.5 h from Tai zhou first people’s hospital and the first affiliated hospital of Wenzhou medical college between 2007 and 2012 were reviewed.NINDS research data and ECASS-3 research data were applied as the control for this research.Results: Compared with classical experiment,statistical significance showed thrombolysis improved recent and long-term prognosis.The 24-h improvement rate achieved 52.1%,and the rate of good prognosis after three months achieved 46.9%.Although intracranial hemorrhage risk increased,asymptomatic intracranial hemorrhage was dominated,and the total death rate was not increased.According to the analyses,the mark of good prognosis and baseline NHHSS ≤12 were related with 24-hour improvement rate.Conclusion: As long as the indication and contraindication of thrombolysis are mastered strictly,alteplase for intravenous thrombolysis within 4.5 h is effective and safe,especially for patients suffering light and moderate apoplexy(NIHSS≤12).The prognosis of patients with cerebral infarction can be improved,and the poor prognosis is greatly related to baseline apoplexy.