静脉rtPA溶栓治疗脑梗死的安全性与有效性  

Safety and Efficacy in Ischemic Stroke Patients Treated with Recombinant Tissue Plasminogen Activator

作　　者：陶庆玲[1] 赵晖[1] 许敏[1] 

机构地区：[1]上海市长宁区中心医院神经内科,上海200336

出　　处：《中国临床医学》2004年第4期485-487,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :分析重组组织型纤溶酶原激活物 (rtPA ,爱通立 )静脉溶栓治疗急性脑梗死的安全性与有效性。方法 :80例急性脑梗死患者分为rtPA组和对照组各 4 0例。rtPA组给予rtPA总量 0 .8mg/kg ,90min内静脉滴入。对照组应用低分子右旋糖酐5 0 0ml加复方丹参 16ml静滴 ,每日 1次 ,连用 10d。统计两组发生颅内出血的例数 ,依据头颅CT所见将出血转化分为出血性梗死、脑实质性出血 2种类型。用欧洲脑卒中临床神经缺损评分标准 (ESS)和Barthel指数进行疗效评定。结果 :rtPA组疗效明显优于对照组 (P <0 .0 1) ,rtPA组发生颅内出血 4例 ,其中出血性梗死 1例 ,脑实质性出血 3例 ,死亡 2例。对照组发生颅内出血 2例 ,均为出血性梗死 ,死亡 1例。结论 :rtPA静脉溶栓治疗急性脑梗死疗效确实 ,但脑实质性出血高于对照组 ,主要见于高龄。Objective: To investigate the safety, and efficacy in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator(rtPA). Methods: 80 patients with acute cerebral infarction were randomly divided into rtPA group(40例) and control group(40例). rtPA was administered in a dose of 0.8 mg/kg body weight (maximum dose 50mg),with 100% as a constant infusion over a period of 90 minutes in rtPA group. Whereas the control group received only routine treatment. Hemorrhagic transformation were classified by using radiological criteria as follows: hemorrhagic infarction(HI), parenchymal hemorrhage(PH). The neurologic function deficits of patients with both group were evaluated before and after the treatment. Results: The efficacy in rtPA group was significantly higher than that in control group(P<0.01). Also, PH but not HI were more severe in rtPA-treated patients than in those receiving only routine treatment. Conclusion:Thrombolytic therapy of intravenous rtPA can be performed efficaciously in Chinese patients with acute ischemic stroke.The findings also suggest that older patients(>75 years) and atrial fibrillation are at higher risk of a severe pH on rtPA.

关 键 词：静脉溶栓 脑梗死 安全性 有效性 RTPA 重组组织型纤溶酶原激活物 溶栓治疗 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R973.2[医药卫生—临床医学]