阿替普酶动静脉溶栓治疗急性缺血性脑卒中的比较性研究  

Efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke： a comparative study

作　　者：林念童[1,2] 杨碧萍[2] 冼树清[3] 潘速跃[1] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]广州医学院第一附属医院神经内科,广州510120 [3]广州医学院第一临床学院,广州510120

出　　处：《中华神经医学杂志》2012年第10期1030-1033,共4页Chinese Journal of Neuromedicine

摘　　要：目的 比较阿替普酶溶栓治疗急性缺血性脑卒中时静脉溶栓和动脉溶栓的有效性和安全性的差异。方法 回顾性分析广州医学院第一附属医院自2005年初至2010年底连续登记在库的急性缺血性脑卒中患者的临床资料，包括患者入院时人口学特征、溶栓时间窗、院内时间延误、溶栓途径、阿替普酶剂量、脑卒中严重程度、各项生化和凝血指标及溶栓前重要生命体征，以及CT表现和脑卒中TOAST分型，评价溶栓后出血性转化、血管再通分级和溶栓后90d预后及死亡率。采用变量筛选技术挑选影响预后的可能因素，并用二元Logistic回归模型分析独立影响因素。结果本研究共人选96例患者，1例失访，其中男性43例（44．8％），女性53例（55．2％）；年龄中位数72岁，体质量中位数58．5kg；溶栓时间窗中位数4.3h；静脉溶栓64例，动脉溶栓32例；溶栓后90d预后良好率为43．8％，死亡率为17．9％。单因素分析显示，动脉溶栓组较静脉溶栓组男性患者比例较高（71．9％ vs 31．3％），总费用明显偏高（47623．6元 vs 25699．8元），院内延误时间（3．17h vs 1．73h）和溶栓时间窗（5．54h vs 3．58h）明显延长，阿替普酶用量明显偏少（20mg vs 50mg），差异均有统计学意义（P〈0．05）；2组溶栓后36h内责任血管再通率（64．9％ vs 53．8％）、出血转化率（25％ vs 31．3％）、90d预后良好比例（45.3％ vs 40．6％）和死亡率（14．7％ vs 3．2％）比较差异均无统计学意义（P〉0．05）。多因素Logistic回归显示溶栓方式对预后无显著影响（0R=0．54，P=0．824，95％CI：0．00-131．46）；血管再通良好是预后良好独立保护因素（0R=0．11，P=0．027，95％CI：0．02．0．78），但不同溶栓方式对血管再通无显著影响。结论在急性缺血性脑卒中的溶栓治疗中，阿替普酶动脉溶栓和静脉溶栓后90d预后良好比例相Objective To compare the efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke. Methods Patients with acute ischemic stroke, consecutively registered in our database from 2005 to 2010, were included. Admission demographics, time window, procedure delay in hospital, route of thrombolysis, dose of tissue plasminogen activator, stroke severity, laboratory tests and vital signs of these patients were collected. CT manifestations and TOAST subtypes were obsevred. Outcome variables included hemorrhagic transformation, re-canalization of responsible vessels, favorable functional outcome 90 d after thrombolysis and mortality were evaluated. Univariate and multivariate logistic regression were used to select the potential variables and compare the differences between the two kinds of route in thrombolysis. Results A total of 96 patients were included with one loss of follow-up. Forty-three were male （44.8%） and 53 female. Median age was 72 years, median body weight 58.5 kilograms, and median time window 4.3 hours. Sixty-four patients received intravenous thrombolysis and 32 patients intra-arterial thrombolysis. Favorable outcome was achieved in 43.8% patients 90 d after thrombolysis with a mortality reaching 17.9%. Univariate analysis showed intra-arterial thrombolysis had a much higher cost （47623.6 vs 25699.8 RMB）, longer procedure delay （3.17 h vs 1.73 hours） and time window （5.54 vs 3.58 hours）, and lower dose （20 vs 50 mg） as compared with intravenous thrombolysis （P〈0.05）; however, no significant differences were found between the 2 groups in re-canalization of responsible vessels （64.9% vs 53.8%）, hemorrhagic transformation （25% vs 31.3%）, favorable outcome （45.3% vs 40.6%） and mortality （14.7% vs 3.2% ）. Multivariate logistic regression indicated that route of thrombolysis did not predict unfavorable outcome （OR=0.54, P=0.824, 95% CI： 0.00-131.46）; re-canalization could inde

关 键 词：急性缺血性脑卒中 动脉溶栓 静脉溶栓 阿替普酶 比较性研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]