天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (5): 521-524.doi: 10.11958/20181636

• 临床研究 • 上一篇    下一篇

不同时间窗阿替普酶在脑梗死患者中的疗效及对认知功能的影响

冯丽娜，王宏   

  1. 基金项目：第三次中国国家卒中登记研究及亚组课题研究（编号：CNSR3）-石河子大学医学院第一附属医院（分中心编号160） 作者单位：石河子大学医学院第一附属医院神经内科（邮编832008） 作者简介：冯丽娜（1981），女，硕士，主治医师，主要从事神经内科脑血管病方面研究
  • 收稿日期:2018-10-26 修回日期:2019-03-21 出版日期:2019-05-15 发布日期:2019-05-15
  • 通讯作者: 冯丽娜 E-mail:fenglina106@163.com
  • 基金资助:
    第三次国家卒中登记（CNSR3）-石河子大学医学院第一附属医院

Effects of different time windows of alteplase on cognitive function of patients with cerebral infarction

FENG Li-na, WANG Hong   

  1. Department of Neurology, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi 832008, China
  • Received:2018-10-26 Revised:2019-03-21 Published:2019-05-15 Online:2019-05-15

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摘要： 摘要：目的 分析不同时间窗阿替普酶在脑梗死患者中的疗效及对认知功能的影响。方法 选择 2016 年 1 月—2018年4月我院诊治的95例脑梗死患者，按照患者接受阿替普酶静脉溶栓时间分为2组，观察组为发病距离溶 栓时间＜3 h的患者45例，对照组为发病距离溶栓时间在3～4.5 h的患者50例。分析2组患者的治疗效果、神经功能 恢复、认知功能以及脑出血情况。结果 治疗后7 d，2组总有效率差异无统计学意义（88.9% vs. 82.0%，P＞0.05）；2 组患者经阿替普酶治疗后1 d与7 d的NIHSS评分、MESSS评分均低于治疗前（均P＜0.05）；同时观察组在治疗后1 d 与 7 d 的 NIHSS 评分［（7.13±2.42）分、（4.85±1.76）分］、MESSS 评分［（8.48±2.72）分、（5.61±2.05）分］均低于对照组 ［（8.48±2.86）分、（6.08±2.31）分；（10.08±3.09）分、（7.23±2.81）分］（均P＜0.05）；治疗后7 d，观察组的MRS评分等级 ［预后良好（91.11%）、预后不良（8.89%）、死亡（0）］明显优于对照组［预后良好（76.00%）、预后不良（20.00%）、死亡 （4.00%）］（P＜0.05）；治疗后7 d，观察组出现脑出血发生率为2.22%，低于对照组的14.00%（P＜0.05）。结论 脑梗 死患者在发病距离溶栓时间＜3 h采用阿替普酶静脉溶栓治疗可明显改善患者的神经功能以及认知功能，降低脑出 血发生率。

关键词: 脑梗死, 阿替普酶, 静脉溶栓, 不同时间窗, 神经功能, 认知功能

Abstract: Abstract: Objective To compare the effects of different time windows of alteplase on cognitive function in patients with cerebral infarction. Methods Ninety-five patients with cerebral infarction who were treated in our hospital from January 2016 to April 2018 were divided into two groups according to the time of intravenous thrombolytic therapy with alteplase. The observation group included patients with thrombolytic time <3 h, and the control group consisted of 50 patients with 3 to 4.5 h from onset to thrombolysis. The therapeutic effects, neurological recovery, cognitive function and cerebral hemorrhage were analyzed in the two groups. Results After 7-day treatment, there was no significant difference in the total effective rate between the two groups (88.9% vs. 82.0%, P＞0.05). The NIHSS score and MESSS score were significantly higher after one-day and seven-day treatment with alteplase than those before treatment in two groups (all P＜0.05). At the same time, the NIHSS scores and MESSS scores were significantly lower after one-day and seven-day treatment in the observation group［(7.13±2.42) points, (4.85±1.76) points for NIHSS and(8.48±2.72) points, (5.61±2.05) points for MESSS］ than those of control group [(8.48±2.86) points, (6.08±2.31) points for NIHSS and (10.08±3.09) points, (7.23±2.81) points for MESSS, P＜0.05]. After 7-day treatment, the MRS scores were significantly better in the observation group (good prognosis 91.11%, poor prognosis 8.89% and no death) than those of the control group［good prognosis 76.00%, poor prognosis 20.00% and death 4.00%, P＜0.05]. After 7-day treatment, the incidence rate of cerebral hemorrhage was 2.22% in the observation group, which was significantly lower than that of the control group (14.00%, χ2=4.260, P＜0.05). Conclusion Arteplase intravenous thrombolytic therapy (<3 h from onset to thrombolysis) can significantly improve the neurological and cognitive functions in patients with cerebral infarction and reduce the incidence of cerebral hemorrhage.

Key words: cerebral infarction, alteplase, intravenous thrombolysis, different time windows, neurological function, cognitive function