颈内动脉系统急性脑梗死应用重组组织型纤溶酶原激活物溶栓治疗观察

目的 评价重组组织型纤溶酶原激活物(rtpA)用于颈内动脉系统急性脑梗死（6 h 内）静脉溶栓治疗的有效性与安全性。方法 选择2008年7月至2010年7月颈内动脉系统急性脑梗死患者80例，完全随机分为溶栓组和对照组，各40例。溶栓组接受rtPA 5 mg于1h内静脉推注，继以45 mg rtPA于1h内静脉滴注；溶栓后24h口服肠溶阿司匹林100 mg，1次/d。对照组应用常规改善循环、营养神经药物静脉滴注；人院后24h予肠溶阿司匹林100 mg口服，1次/d。所有患者治疗前均行头CT或MRI、凝血时间、血、尿常规及心电图检查，并记录既往史评分。治疗前后采用改良爱丁堡-斯堪的那维亚量表(MESSS)进行评定，记录溶栓前、溶栓后2、24h和3、7、14、30、90d的得分。记录2组不良反应及并发症情况。研究终点为治疗后90d。结果 溶栓组治疗后24h，3、7、14、30、90d的MESSS分值[分别为(14.43 ±11.61)、（9.88±10.44）、(9.27±9.66)、(8.27 ±9.54)、(7.79±9.13)、(5.13±6.75)分]均明显低于对照组[(24.23±6.23)、(21.37±4.12)、(21.17±3.68)、(18.53±3.55)、( 15.87±3.49)、(9.98±1.95)分]，差异具有统计学意义(P＜0.05)。溶栓组发生非症状性脑出血1例，牙龈出血2例。结论 急性脑梗死6h内rtPA静脉溶栓治疗是有效、安全的。

Observation of intravenous recombinant tissue-type plasminogen activator thrombolytic therapy in acute cerebral infarction (6 hours) of carotid artery

Objective To evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator(rtPA) for the therapy of acute cerebral infarctions within 6 hours from symptom onset. Methods A randomized and controlled clinical study was performed. Forty patients consistent with the thrombolysis group criteria received rtPA 50 mg intravenously in one minute. 24 hours after thrombolysis, 100 mg aspirin was administered perday. Meliorate scandinavian stroke scale (MESSS) was used to evaluate the neurological deficits and the MESSS scores were recorded on the following time points: pretherapy, 2 hours, 24 hours, 3 days, 7 days, 14 days, 30 days, and 90 days after thrombolysis. Forty patients consistent with the controlled group criteria received routine treatment. 24 hours after entering wards, 100 mg aspirin was administered per day. MESSS was used to evaluate the neurological deficits and the MESSS scores were recorded on the following time points: pretherapy, 24 hours, 3 days, 7 days, 14 days, 30 days, and 90 days after therapy. All patients received head CT scan or MRI, complete blood count, coagulative time, electrocardiogram before therapy. Results Compared with control group[(24.23 ±6.23) ,(21.37 ±4.12),(21.17 ±3.68), (18.53 ±3.55), (15.87 ±3.49), (9.98 ± 1.95) scores], MESSS scores of thrombolysis group 24 hours, 3 days, 7 days, 14 days, 30 days, and 90 days after therapy[( 14.43 ±11.61) ,(9.88 ± 10.44),(9.27 ±9.66),(8.27 ±9.54),(7.79 ±9.13),(5.13 ±6.75) scores]decreased rapidly after thrombolysis. There was significant difference between 2 groups( P ＜0.05 ). One non-symptomatic hemorrhage onset was found. There was not dead case. Conclusion rtPA is effective and relatively safe in treatment of acute cerebral infarctions within 6 hours after symptom onset.