rt-PA治疗急性脑梗死的临床研究  

Recombinant Tissue Plasminogen Activator (rt-PA) Therapy for Acute Cerebral Infarction

作　　者：杨建道[1] 王少石[1] 陈真理[1] 周晓宇[1] 

机构地区：[1]上海交通大学附属第一人民医院分院神经科,上海市200081

出　　处：《中国卒中杂志》2006年第6期397-399,共3页Chinese Journal of Stroke

摘　　要：目的探讨重组组织型纤溶酶原激活剂(rt-PA)治疗急性脑梗死的有效性和安全性。方法选择发病6 h内的急性脑梗死患者5 0例,采用rt-PA(5 0 mg/例)静脉溶栓,其中1 O％剂量5 min内静脉推注,余90%剂量60～90 min内静脉滴注。评定患者治疗前、治疗24 h及21 d时的神经功能缺损程度评分(NIFISS),21 d、90 d日常生活能力评分(ADL)及90 d综合生活能力(改良Rankin评分,mRS)。结果治疗后24 h及21 d的NIHSS评分与治疗前比较差异均有统计学意义(P均＜0．01)。随访3个月,mRS为0～3分者33例(66%);脑出血者7例(14%),其中症状性脑出血3例(6%);死亡13例(26%)。在发病4．5 h内进行溶栓治疗的41例患者中有25例(60%)获得良好预后(mRS为0～1分),在4．5～6 h内进行溶栓治疗的9例患者中只有3例(33%)获得良好预后。13例心源性脑梗死患者仅有5例(38%)获得良好预后。结论在排除心源性脑梗死的情况下,采用rt-PA 50 mg/例治疗发病4．5 h内的脑梗死患者,能够改善神经功能,恢复生活能力。Objective To discuss the efficiency and safety of recombinant tissue plasminogen activator (rt-PA) for patients with acute cerebral infarction.Methods Total 50 patients with acute cerebral infarction were given rt-PA(50mg/ case)after onset within 6 hours,10% of total dose as a bolus in 5 minutes,90% infused in 60-90 minutes.All the cases received head computer tomography (CT) scan after 24 hours and the assessment of nerve function by National Institutes of Health Stroke Scale(N1HSS) score was given before treatment,24hours and 21days after treatment.The assessment of living ability by Activities of Daily Living(ADL) score was given before treatment,21days and 90days after treatment.Modified Rankin's Score(mRS) at 90 days was also assessed.Results There was significant difference in NIHSS between onset and 24hours,21days after treatment (both P＜0.01).There were 33 cases (66%) with mRS 0-3 at 90 days and 13cases (26%)were dead during the study.Totally 7cases(14%)combined with cerebral hemorrhage,3 cases (6%)with symptomatic cerebral hemorrhage.The patients had benefit from rt-PA(50mg/case) in 4.5h therapy.Sixty percent patients using rt-PA in 4.5h achieved better outcome,while 33.33%(3/9) of patients using rt-PA from 4.5h to 6h achieved better outcome.Only 38.46% (5/13)of patients with cardiogenic embolism got better outcome.Conclusion Thrombolysis therapy with rt-PA(50mg/case) in 4.5 h can improve nerve function and living ability of patients with acute cerebral infarction excluding cardiogenic embolism.

关 键 词：重组组织型纤溶酶原激活剂 急性脑梗死 溶栓治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]