不同时间窗重组组织型纤溶酶原激活剂静脉溶栓治疗椎-基底动脉系统脑梗死的疗效  

Effects of intravenous thrombolytic therapy with recombinant tissue plasminogen activator for vertebrobasilar system cerebral infarction within different time windows

作　　者：沈健[1] 白青科[1] 赵振国[2] 赵晓晖[1] 陆练军[1] 朱玉萍[1] 周媛[1] 陈娟[1] 杨娟[1] 

机构地区：[1]上海市浦东新区人民医院神经科,201200 [2]上海市浦东新区人民医院放射科,201200

出　　处：《临床神经病学杂志》2012年第4期302-304,共3页Journal of Clinical Neurology

基　　金：上海市浦东新区卫生系统重点学科建设基金(PWZXK2010-03);浦东新区卫生系统领先人才培养基金(PWR12010-02);浦东新区科技发展基金创新资金(PKJ2010-Y28)

摘　　要：目的探讨不同时间窗重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗椎-基底动脉系统脑梗死的疗效。方法对26例经多模式MRI证实的椎-基底动脉系统脑梗死患者行rt-PA静脉溶栓治疗,治疗时间窗<4.5 h组和4.5～9 h组各13例。患者在治疗前及治疗后24 h、14 d、90 d进行美国国立卫生研究院卒中量表(NIHSS)评分,90 d时行Bathel指数(BI)、改良Rankin量表(mRs)评分,比较两组的疗效;观察溶栓后有无脑出血发生。结果 <4.5 h组与4.5～9 h组各时间点NIHSS、BI及mRs评分差异无统计学意义。<4.5 h组与4.5～9 h组各有1例非症状性脑出血。90 d时,<4.5 h组mRS评分预后良好7例(53.85%);4.5～9 h组6例(46.15%),两组预后良好率的差异无统计学意义。结论椎-基底动脉系统脑梗死静脉rt-PA溶栓治疗4.5 h时间窗和适当延长治疗时间窗均安全有效。Objective To investigate the effects of intravenous thrombolytic therapy with recombinant tissue plasminogen activator （rt-PA） for vertebrobasilar system cerebral infarction within different time windows. Methods Twenty-six vertebrobasilar system cerebral infarction patients who confirmed by multi-modality MRI were treated with rt-PA intravenous thrombolytic therapy. The time window 〈 4.5 h group and 4.5 - 9 h group were 13 cases respectively. The national institutes of health stroke scale （NIHSS） was assessed at pre-therapy and 24 h, 14 d, 90 d post therapy. Barthel Index （BI） and modified Rankin Scale （ mRS ） were assessed at 90 d after therapy. The efficacy was compared between the 2 groups. Whether no cerebral hemorrhage happen post-therapy was observed. Results The scores of NHISS, BI and mrs at each time point between 〈 4.5 h group and 4.5 - 9 h group were no statistical difference. The 1 case in each group was happend with non-symptomatic intracerebral hemorrhage. At 90 d after therapy, mrs score of good prognosis in 〈4.5 h group was 7 cases （53.85%）, and in 4.5 -9 h group was 6 cases （46.15%）. The rate of good prognosis in the 2 groups was no statistical difference. Conclusion The time window of intravenous thrombolytic therapy with rt-PA for vertebrobasilar system cerebral infarction within 4.5 h or prolonging properly is effective and safe.

关 键 词：椎-基底动脉系统 脑梗死 静脉溶栓 重组组织型纤溶酶原激活剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]