rt-PA静脉溶栓治疗超早期脑梗死的临床疗效观察  

Clinical curative effects observation of recombinant tissue plasminogen activator( rt-PA) intravenous thrombolytic therapy for super early cerebral infarction

作　　者：韩晶[1] 

机构地区：[1]北京市顺义区医院神经内科,北京101300

出　　处：《中风与神经疾病杂志》2013年第9期833-835,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的对比急性缺血性脑卒中3h内与3h^4.5h之间静脉使用重组组织型纤溶酶原激活物(rtPA)溶栓的临床疗效与安全性。方法将41例符合标准的超早期脑梗死患者按溶栓时间分为2组(A组:发病距溶栓时间<3h者26例、B组:发病距溶栓时间3~4.5h者15例),均按0.9mg/kg静脉给予rt-PA,24h后头部CT证实无出血者,用拜阿司匹林100mg+氯吡格雷75mg口服14d,并辅以脑保护制剂治疗。观察溶栓后2h、24h、7d、14d的神经功能缺损的评分变化(NIHSS)、90d时的改良Rankin量表评分(mRS)及治疗总有效率评估临床疗效。结果两组溶栓后2h、24h、7d、14d时,NIHSS评分较溶栓前均明显减少,有显著差异(P<0.01),但两者在2h、24h、7d和14d同一时间点比较无差异(P>0.05);治疗后90d,改良Rankin量表评分分别为1.58±1.25和2.2±1.52(P>0.05),总有效率分别达73.07%和66.67%,两组均无统计学差异(P>0.05)。溶栓后24h、7d、14d复查头部CT,A组有2例发生无症状性脑出血,B组没有发生。B组死亡1例,死于大面积脑梗死,没有发生脑出血,考虑为溶栓失败。结论 rt-PA静脉溶栓治疗超早期脑梗死在3h内与3h^4.5h之间使用同样安全、有效。Objective To compare the clinical curative effect and security of recombinant tissue plasminogen acti- vator （rt-PA） in intravenous thrombolysis for acute ischemic stroke within 3h and 3h -4.5h. Methods 41 patients con- forming super early stage of cerebral infarction were divided into 2 groups according to thrombolysis time （Group A ：26 ca- ses, thrombolysis attacking time 〈 3h, group B ： 15 cases, incidence of thrombolysis time 3 - 4.5h）, rt-PA 0.9 mg/kg were given by intravenous. Head CT shows no bleeding after 24 hours, 100 mg aspirin plus 75 mg clopidogrel were taken orally for 14 days,supplemented by treatment of brain protection. Utilized National Institutes of Health Stroke Scale （NIHSS） to observed neural function defect changes at 2 hours,24 hours,7 days and 14 days after thrombolysis and test the modified Rankin Scale （mRS） at 90 d and evaluate of the total effective rate of clinical curative effect. Results NIHSS scores were significantly decreased after using rt-PA in two groups at 2 hours,24 hours,7 days and 14 days after thrombolysis, there were significant differences （P 〈 0. O1 ） ;but there was no difference between the two groups at the same point of 2h ,24h,7d and 14d （ P 〉. 05 ） ; the modified Rankin scale good clinical outcomes were 1.58 ± 1.25 ±11 2.2 ± 1.52 （ P 〉 0.05 ） 90d after treatment,total effective rates were 73.07% and 66.67% respectively ,two groups had no statistical difference between them （P 〉0.05）. Head CT were reviewed at 24h,7 d and 14 d after thrombolysis,Group A had asymptomatic cerebral hemor- rhage occurred in 2 cases. One case in group B died of large area cerebral infarction with no cerebral hemorrhage, consider- ing the failure of thrombolysis. Conclusion rt-PA intravenous thrombolysis is effective and safe for treating super early stage of cerebral infarction（CI） within 3h and 3h-4.5h.

关 键 词：脑梗死 重组组织型纤溶酶原激活物（rt-PA） 静脉溶栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]