天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (9): 961-941.

• 临床研究 • 上一篇    下一篇

rt-PA 动脉溶栓治疗缺血性脑血栓的疗效观察

田仲兰，徐玲玲，张勇，杨春，何改平△   

  1. 南开大学附属医院（天津市第四医院）神经内科（邮编 300222）
  • 收稿日期:2017-03-06 修回日期:2017-07-12 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 田仲兰 E-mail:tajo54@qq.com

The clinical efficacy of recombinant tissue plasminogen activator for the treatment of ischemic cerebrovascular disease caused by cerebral thrombosis

TIAN Zhong-lan, XU Ling-ling, ZHANG Yong, YANG Chun, HE Gai-ping△   

  • Received:2017-03-06 Revised:2017-07-12 Published:2017-09-15 Online:2017-09-25

PDF (PC)

3653

摘要： 摘要：目的 研究重组组织型纤溶酶原激活剂（rt-PA）动脉溶栓治疗缺血性脑血栓的临床疗效。方法 2013 年 5 月—2015 年 7 月期间我院收治的缺血性脑血栓患者 245 例，随机数字表法分为观察组 148 例和对照组 97 例，所 有患者均进行血压、血脂等常规控制，观察组患者行 rt-PA 动脉溶栓，对照组患者接受常规治疗。于患者入院时，收 集人口统计学特征、血管影响因素、基线临床情况、实验室检查结果和神经功能缺损评分；于发病后 3 个月时应用改 良 Rankin 量表评价神经功能恢复情况；于治疗前和治疗后 24 h 测定患者的血浆纤维蛋白原（FIB）、D-二聚体（DDimer）、活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）。结果 2 组患者各人口统计学和一般临床资料差异 均无统计学意义（P＞0.05）；观察组神经功能改善者比例显著高于对照组（83.11% vs. 53.61%，P＜0.05）。治疗前，2 组患者的凝血指标和纤溶指标差异均无统计学意义（P＞0.05）；治疗后 24 h，观察组的 FIB、D-Dimer、APTT 和 PT 与 治疗前相比均显著改善，与对照组比，FIB 降低、D-Dimer 升高、APTT 和 PT 均延长（均 P＜0.05）。结论 rt-PA 动脉 溶栓用于缺血性脑血栓的治疗，可以有效溶解血栓，纠正凝血系统和纤溶系统。

关键词: 缺氧缺血, 脑, 颅内栓塞和血栓形成, 纤维蛋白溶解药, 治疗结果, 重组组织型纤维酶原激活剂

Abstract: Abstract: Objective To study the clinical efficacy of intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) for the treatment of ischemic cerebrovascular disease caused by cerebral thrombosis. Methods A total of 245 patients accepted by our hospital during May 2013 and July 2015 were divided into the observation group (n=148) and the control group (n=97). All patients were given conventional process for controling blood pressure and blood lipids. Patients in observation group received intra- arterial thrombolysis with rt- PA, while patients in control group accepted conventional treatment. At the time of admission, the demographic characteristic, vascular influencing factors, baseline clinical findings, laboratory findings and neurological deficits were collected. The improvement of neurological function was evaluated by the modified Rankin scale 3 months after treatment. The levels of fibrinogen (FIB), D-Dimer, activated partial thromboplastin time (APTT) and thrombin time (PT) were measured before and 24 h after the treatment. Results There were no significant differences in demographic characteristic and general clinical data between the two groups (P＞0.05). The proportion of patients with improved neurological function was significantly higher in observation group than that of the control group (83.11% vs. 53.61%, P＜0.05). There were no significant difference in coagulation index and fibrinolysis index before treatment between the two groups (P＞0.05). Twenty- four hours after the treatment, the levels of FIB, D- Dimer, APTT and PT were significantly improved in the observation group compared with those before treatment. The level of FIB was significantly decreased, D-Dimer was significantly increased, APTT and PT were significantly prolonged in observation group compared with those of control group (P＜0.05). Conclusion The rt- PA can effectively dissolve thrombosis and correct the coagulation system and fibrinolytic system.

Key words: hypoxia- ischemia, brain, intracranial embolism and thrombosis, fibrinolytic agents, treatment outcome, recombinant tissue plasminogen activator