不同时间窗rt-PA溶栓治疗椎-基底动脉系统脑梗死的疗效及安全性分析

目的 探讨不同时间窗重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗椎-基底动脉系统（VBA）脑梗死的临床疗效及安全性.方法 根据不同溶栓时间窗,对62例VBA脑梗死分为两组：＜4.5h组和4.5 ～6.0h组,各31例.采用rt-PA静脉溶栓治疗,比较不同时间窗及不同年龄组间溶栓的疗效及不良反应.结果 溶栓后,两组NIHSS评分均较溶栓前显著下降（P＜0.05）;＜4.5h组、4.5～6.0h组溶栓后各时间点NIHSS评分差异均无统计学意义（P＞0.05）;溶栓后,两组BI指数均较溶栓前显著升高（P＜0.05）;溶栓后90天,＜4.5h组BI指数显著高于4.5 ～6.0h组（P＜0.05）;4.5～6.0h组＜60岁患者的有效率47.1％,显著低于＜4.5h组有效率77.4％ （P ＜0.05）,而4.5 ～6.0h组年龄≥60岁患者与＜4.5h组总有效率比较,差异无统计学意义（P ＞0.05）;4.5h内溶栓不增加出血的风险,而4.5 ～6.0h溶栓中,年龄≥60岁患者出血的风险较低.结论 VBA脑梗死发病6h内使用rt-PA静脉溶栓治疗均是安全、有效的,4.5h内溶栓预后相对更好.对于发病4.5 ～6h的患者内不应轻易放弃溶栓治疗.

Effect and Safety of Recombinant Tissue Plasminogen Activator Thrombolysis at Different Time Window for Vertebrobasilar System Cerebral Infarction

Objective To investigate the clinical efficacy and safety of recombinant tissue plasminogen activator （rt-PA） thrombolysis at different time window for vertebrobasilar system （VBA） cerebral infarction.Methods According to different thrombolysis time,62 patients were divided into two groups including ＜4.5h group （n =31） and 4.5-6.0h group （n =31）.All the patients were treated with rt-PA thrombolysis,and the clinical effect and side effect was analyzed between different time window and ages.Results The score of NIHSS in all patients was significant lower than that before treatment （P ＜ 0.05）,while there was no significant difference at different treatment points between two groups （P ＞ 0.05）.The index of BI in all patients was significant increased than that before treatment （P ＜ 0.05）,and it was remarkably higher in ＜ 4.5h group compared with that in 4.5 ～ 6.0h group at treatment for 90 days （P ＜ 0.05）.The effective rate in patients under 60 years old of 4.5 ～ 6.0h group was 47.1％,which was significant lower than 77.4％ in ＜ 4.5h group （P ＜ 0.05）,while there was no significant difference between over 60 years old of 4.5 ～6.0h group and ＜ 4.5h group（P ＞ 0.05）.Thrombolysis at ＜ 4.5h did not increase the risk of haemorrhagia,and there was lower risk of haemorrhagia for thrombolysis at 4.5 ～ 6.0h among patients over 60 years old.Conclusion It is safe and effective of rt-PA thrombolysis within 6 hours for VBA cerebral infarction,particularly within 4.5 hours.We should not easily give up the thrombolysis treatment opportunity for patients within 4.5 ～ 6.0h.