低剂量尿激酶与重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的疗效  

Intravenous thrombolysis with rt-PA and low dose urokinase for acute cerebral infarctions

作　　者：张鹏[1] 高志强[1] 孙高慧[1] 戴瑛[1] 高俊凤[1] 贾鹏[1] 

机构地区：[1]南京医科大学第二附属医院神经内科,南京210011

出　　处：《中国实用神经疾病杂志》2013年第24期4-6,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的 比较低剂量尿激酶（UK）与重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性脑梗死的有效性和安全性.方法选择发病＜6 h的急性脑梗死患者42例,分为rt-PA（0.9 mg/kg）静脉溶栓组23例,低剂量UK（50万～70万IU）静脉溶栓组19例,对2组治疗前、治疗后24 h、10 d的神经功能缺损（NIHSS）评分及治疗前与治疗后10 d的日常生活（barthel）指数评分进行比较,同时观察2组溶栓后出血等不良反应.结果 （1）rt-PA组及UK组治疗后24 h、10 d的NIHSS及Barthel评分与溶栓治疗前相比均有显著改善（P＜0.05）;2组间溶栓治疗前及治疗后24 h、10 d的NIHSS、Barthel评分比较差异无统计学意义 （P＞0.05）.（2）rt-PA组治疗后总有效率为95.7%,UK组为78.9%,rt-PA组总有效率较UK组高,但2组比较差异无统计学意义 （P＞0.05）.UK＜3 h组总有效率92.3%,UK3～6 h组总有效率50.0%,rt-PA治疗组总有效率与UK3～6 h组比较差异有统计学意义 （P＜0.05）.（3）溶栓后rt-PA组脑出血2例,均为非症状性,UK组无脑出血,2组均无其他系统出血并发症.结论低剂量尿激酶静脉溶栓治疗3 h内急性脑梗死与rt-PA相比同样有效,且安全性更好.Objective To evaluate the clinical efficacy and safety of intravenous thrombolysis with low dose urokinase （UK） and recombinant tissue plasminogen activator（rt-PA） in patients with acute cerebral infarction. Methods Forty-two pa- tients were divided into rt-PA group and low dose UK group, with 23 patients in rt-PA（0.9 mg/kg） group and 19 in low dose UK（500 000-700 000IU） group. The scores of National Institutes of Health Stroke Scale（NIHSS） about neurological deficits and Barthel index about daily life before thromholysis and 24 hours, 10 days after thrombolysis were calculated, while observ- ing whether brain and other systems had bleeding complications or not. Results （1）NIHSS and Barthel index scores at 24 hours and 10d of two groups after thrombolysis significantly improved more than before thrombolysis （P〈0.05）. There were not significant differences in NIHSS and Barthel index scores between the two groups before and after treatment（P〉0.05）. （2） The effective rate of the rt-PA group is 95.7%, and the low dose UK group is78.9%. There were not significant differences between the two groups（P〉0. 05）. The effective rate of the UK（〈3 h） group is 92.3%, and the UK（3~6 h） group is 50.0K. There were significant differences between the rt-PA group and UK（3-6 h） group（P〈0.05）. （3）There were two cases with asymptomatic intracerebral hemorrhage in rt-PA group and none in low dose UK group. Two groups had no other system bleeding complications. Conclusion The efficacy and safety of intravenous thromholysis with low dose UK and rt-PA are similar in patients with acute cerebral infarction within 3 hours.

关 键 词：脑梗死 静脉溶栓 尿激酶 重组组织型纤溶酶原激活剂 

分 类 号：R743.33[医药卫生—神经病学与精神病学]