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3小时内rt-PA静脉溶栓治疗急性脑梗死疗效分析

李斌   

  1. 天津大港油田总医院神经内科
  • 收稿日期:2011-07-06 修回日期:2012-01-13 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 李斌

Rt-PA within 3 hours of intravenous thrombolytic therapy of acute cerebral infarction

  • Received:2011-07-06 Revised:2012-01-13 Published:2012-07-15 Online:2012-07-15

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摘要： 摘要】　目的: 探讨rt-PA静脉溶栓治疗急性脑梗死的有效性及安全性。方法:选22例急性缺血性卒中患者，起病距溶栓的时间为3 h以内，方案为0.9 mg/kg，最大剂量为90 mg。将总剂量的10％在注射器内混匀，1 min内注射。将剩余的90％加入液体，以输液泵静点，持续1 h以上。对照组21例常规治疗。观察两组治疗前后NHISS评分与 Barthel 指数（BI）。改良Rankin量表（mRS）评定90 d的综合生活能力。安全指标：死亡、继发出血以及其他不良事件。结果: 患者溶栓治疗后24 h、14 d、90 d的NHISS评分较对照组明显下降，差异有统计学意义（P﹤0.05），治疗后24h、14d、90d溶栓组的BI评分均高于对照组。有统计学意义（P﹤0.05），尤其是在溶栓后24hBI评分比对照组改善更明显（P﹤0.01）。90 d随访时，BI 评分和mRS评分溶栓组较对照组明显获益，差异有统计学意义（P﹤0.05）。两组总体不良事件及严重不良事件无明显差异，无统计学意义（P﹥0.05）结论: 早期rt-PA静脉溶栓是治疗急性脑梗死有效和相对安全的方法。

关键词: 急性脑梗死, 静脉溶栓, 重组组织型纤维蛋白溶酶原激活剂（rt-PA）, 疗效观察

Abstract: Objective : to evaluate the efficacy and safty of thrombolysis by intravenous rt-PA in acute cerebral infarction. Methods: 22 cases of acute ischemic stroke patients with intravenous thrombolysis; Onset time from thrombolysis within 3h， program for the 0.9 mg/kg， maximum dose 90mg. The total dose of 10％ mixing in syringes，In 1 min injection. The remaining 90% liquid is added to an infusion pump, the static point, sustained over 1 h. A control group of 21 patients treated with conventional therapy. Outcome measures：Two groups before and after treatment with NHISS score and Barthel index ( BI)。A modified Rankin scale 90d integrated living ability。Safety index:Death， bleeding， and other Adverse events .Results: After thrombolytic therapy in patients with 24h， 14d， 90d NHISS score decreased significantly compared with the control group， the difference was statistically significant ( P < 0.05). After treatment, 24h, 14d, 90d thrombolysis group BI scores were higher than that of the control group. There were statistically significant ( P < 0.05 ), especially in the thrombolysis after 24hBI score than the control group improved more obviously ( P < 0.01 ). 90 d follow-up, the BI score and mRS score significantly benefit from thrombolysis group than in the control group, the difference was statistically significant ( P < 0.05 ) Two groups of overall adverse events and serious adverse events have no obvious difference, without statistical significance ( P > 0.05 ). Conclusion: Early rt-PA intravenous thrombolysis in treating acute cerebral infarction is effective and relatively safe method.

Key words: acute cerebral infarction, intravenous thrombolysis, rt-PA, Observation of curative effect