rt-PA与尿激酶溶栓治疗急性脑梗塞115例疗效比较

目的 观察重组组织型纤溶酶原激活剂（rt-PA）与尿激酶（UK）溶栓治疗急性脑梗塞的疗效差异及安全性.方法 通过回顾性病例研究的方法,分析2006年9月至2010年1月神经内科住院急性缺血性脑梗塞患者115例的相关资料,其中应用rt-PA溶栓的患者23例,应用UK溶栓的患者92例.比较两组患者溶栓后24h、7d的NIHSS、溶栓后14d的mRS评分、症状性颅内出血（SICH）以及死亡率,进而比较两组的疗效及安全性.结果 （1）溶栓后24 h rt-PA组NIHSS评分下降（4.0±4.9）分,UK组NIHSS评分下降（3.7±5.2）分,差异无统计学意义（P=0.80）；溶栓后24 h rt-PA组NIHSS评分下降≥4分者9例,UK组下降40例,差异无统计学意义（P=0.71）；溶栓后7 d rt-PA组NIHSS评分下降（3.9±7.7）分,UK组下降（5.2±7.8）分,差异无统计学意义（P=0.48）；溶栓后7 drt-PA 组NIHSS评分下降≥4分者14例,UK组有58例,差异无统计学意义（P=0.85）；溶栓后14 d rt-PA组mRS评分为（2.4±1.6）分,UK组为（2.4±1.6）分,差异无统计学意义（P=0.932）；溶栓后14 d rt-PA组mRS＜2分者13例,UK组有52例,差异无统计学意义（P=1）.提示rt-PA组和UK组在溶栓疗效上差异无统计学意义.（2） rt-PA组发生SICH者2例,UK组有7例,差异无统计学意义（P=0.86）；溶栓后1周内死亡者rt-PA组有4例,UK组有11例,差异无统计学意义（P=0.49）.提示rt-PA组和UK组在溶栓安全性上差异无统计学意义.结论 rt-PA与UK溶栓治疗急性脑梗塞的疗效差异和安全性相似,UK较rt-PA廉价,可优先选择.

Comparison on the efficacy of intravenous thrombolysis between rt-PA and urokinase for treating acute cerebral infarction.

Objective To observe the efficacy and safety of intravenous thrombolysis between rt-PA and uro- kinase （UK） for treating acute cerebral infarction. Methods Through a retrospective case study approach, we ana- lyzed 115 patients with acute cerebral infarction from September 2006 to January 2010, of which 23 were treated with intravenous thrombolysis of rt-PA （rt-PA group） and 92 were treated with intravenous thrombolysis of UK （UK group）. Comparison of efficacy between the two groups was carded out 24 hours and 7 days after medication by National In- stitutes of Health stroke scale （NIHSS） and modified Rankin Scale （mRS） 14 days after medication. Comparison of safety was carried out by SICH and mortality rate 7 days later after medication. Results ① NIHSS score decreased （4.0±4.9） in rt-PA group and （3.7±5.2） in UK group 24 hours after thrombolysis, with no significant difference be- tween the two groups （P=0.80）. There were 9 patients whose NIHSS score decreased no less than 4 scores in rt-PA group 24 hours after thrombolysis, and 40 patients in the UK group, with no significant difference between the two groups （P=0.71）. NIHSS score decreased （3.9±7.7） in rt-PA group and （5.2±7.8） in UK group 7 days after thromboly- sis, with no significant differences between the two groups （P=0.48）. There were 14 patients whose NIHSS score de- creased no less than 4 scores in rt-PA group, and 58 patients in the UK group, with no significant difference between the two groups （P=0.85）. mRS was （2.4±1.6） in rt-PA group 14 days after thrombolysis, and （2.4± 1.6） in the UK group, with no significant difference between two groups （P=0.932）. There were 13 patients whose mRS no more than 2 in rt-PA group, and 52 patients in the UK group, with no significant differences between two groups （P=1）. Research suggests that there were no significant different between the two groups toward the efficacy of thrombolysis. ② There were 2 patients who occur SICH in rt-PA group, and 7 in UK group, with no significant difference between two groups（P=0.86）. There were 4 patients who died in the first week after thrombolysis in rt-PA group, and 11 patients in UK group, with no significant difference between two groups （P=49）. Research suggests that there were no significant different between the two groups toward the safety of thrombolysis. Conclusion The efficacy and safety of intrave- nous thrombolysis with rt-PA and UK for patients with acute cerebral infarction are similar, rt-PA can be the preferred choice as it is much cheaper than UK.