急性脑梗死早期静脉溶栓治疗的临床研究  

Clinical study on early intravenous thrombolysis with r-tPA for acute cerebral infarctions

作　　者：王克英[1] 王雪里红 左鹰[1] 王沈燕[1] 胡南[1] 王洪源[2] 魏岗之[3] 

机构地区：[1]北京急救中心急诊科,100031 [2]北京大学公共卫生学院 [3]首都医科大学宣武医院

出　　处：《中国急救医学》2004年第10期734-735,共2页Chinese Journal of Critical Care Medicine

基　　金：北京市科学技术委员会科研基金资助项目(No.H010210270113)

摘　　要：目的观察我国急性脑梗死患者早期静脉应用艾通立(rt-PA)溶栓治疗的疗效和安全性。方法将发病6h以内的急性脑梗死患者78例分为溶栓治疗和对照两组,治疗组静脉注射溶栓剂rt-PA和皮下注射依诺肝素,对照组不应用此两种药物,其它治疗两组均相同。观察比较患者在治疗后24h和90d神经功能缺损评分及发病90d日常活动指数(Barthel指数)。同时观察两组出血性并发症发生率及30d内病死率并分析死因。结果溶栓治疗组24h显效率487%,而对照组为205%(P=0009),治疗组90d显效率794%,对照组513%(P=0016),90天溶栓组基本完全恢复(barthel95-100)513%,对照组为205%(P=0005),严重致残者治疗组153%,对照组231%(P=002),30d病死率溶栓组103%,对照组128%(P=1000)。出血性并发症溶栓治疗组238%,高于对照组的26%(P=0029),但无致命性出血。结论我国急性脑梗死患者早期接受rt-PA静脉溶栓治疗安全有效,值得进行进一步随机对照研究验证其临床价值。Objective To evaluate the efficacy and safety of r-tPA in the early treatment of the Chinese patients with acute cerebral infarction.Methods 78 patients within 6 hours from the onset of stroke were divided into 2 groups,thrombolytic group and control group.Patients in thrombolytic group received r-tPA 50 mg intravenously and clexane hypodermic over 60 min,and patients in control group did not receive any thrombolytic therapy.The Chinese Stroke Scale(CSS),and Barthel Index(BI) were used to evaluate the recovery of neurological functions after r-tPA 24 hours and 90 days.The hemorrhagic rate and the mortality in 30 days also were analysed.Results In thrombolytic group the 24 h significant effective rate was 48 7%,in control group was 20 5% (P=0 009).The 90d significant effective rate was 79 4% vs 51 3% in thrombolytic and control groups (P=0 016).The 90 d rate of full recovery was 51 3% vs 23 5% in two groups(P=0 005).The significant disability rate was 15 3% vs 23 1% in r-tPA and control groups (P=0 02). The 30d mortility was 10 3% vs 12 8% (P=1 000),no significant difference between two groups.The rate of hemorrhagic complication in thrombolytic group was higher than in control group with 20 5% vs 2 6% (P=0 029),but there was no fatal symptomatic hemorrhage.Conclusion For the Chinese individuals with acute cerebral infartion r-tPA thrombolytsis was effective and safe within 6 h from the symptom onset.A clinical study on large scale is necessary to further evaluate the safety,efficacy and suitable doses. [

关 键 词：脑梗死 静脉溶栓 重组组织型纤溶酶原激活剂 依诺肝素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]