重组组织型纤溶酶原激活剂静脉治疗轻型缺血性卒中患者的疗效分析

目的 观察轻型缺血性卒中患者重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗的疗效及安全性。 

Efficacy and Safety of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in Acute Mild Ischemic Stroke

Objective To observe the efficacy and safety of intravenous thrombolysis with recombinant tissue
plasminogen activator (rt-PA) in patients with acute mild ischemic stroke.
Methods A total of 166 eligible patients from the fist affiliated hospital of Dalian medical
university from January 2016 to September 2017 were included in this study. According to whether
to receive rt-PA intravenous thrombolysis, these patients were divided into thrombolysis group and
control group. The following efficacy and safety outcome between two groups were compared: the
National Institutes of Health Stroke Scale (NIHSS) score at 24 hours and 7 days after thrombolysis,
90-day modified Rankin Scale (mRS), 90-day recurrent ischemic stroke, intracranial hemorrhage
(ICH) and symptomatic ICH.
Results 83 patients in each group. The 24-hour and 7-day NIHSS scores were all lower than
the baseline NIHSS score in thrombolysis group, and the 24-hour and 7-day NIHSS scores in
thrombolysis group were also lower than that in control group, and all the differences were statistically
significant. The proportion of 90-day favorable outcome (mRS≤1) in thrombolysis group was higher
than that in control group (88.0% vs 71.1%, P =0.007). The rate of early neurological deterioration
(defined as the score of NIHSS increasing ≥2 points comparing the baseline score) in thrombolysisgroup was far lower than that in control group (3.6% vs 15.6%, P =0.016). The recurrence rate of
stroke within 90 days between the two groups had no statistical difference (8.4% vs 10.8%, P =0.599).
The incidence of ICH between the two groups also had no statistical difference (6.0% vs 1.2%,
P =0.096). There was no symptomatic ICH case in two groups.
Conclusion For patients with acute mild ischemic stroke, intravenous thrombolysis with rt-PA
within 4.5 h from onset could improve the short-term and long-term neurological function, and
reduce the incidence of early neurologic deterioration, while had no effect on recurrent stroke. The
safety outcome was that thrombolytic therapy did not increase the risk of ICH and symptomatic
ICH in patients with mild stroke.