心源性脑梗死与非心源性脑梗死静脉溶栓的对比研究  

Comparative study of intravenous thrombolysis treatment of cardiogenic cerebral infarction and noncardiac cerbral infarction

作　　者：邓伟华[1] 杨勇[1] 潘小平[1] 李泽[1] 周进[1] 黄翚[1] 陈浩博[1] 

机构地区：[1]广州市第一人民医院神经内科,510180

出　　处：《实用医学杂志》2015年第11期1781-1783,共3页The Journal of Practical Medicine

基　　金：广东省科技厅项目(编号:01581330170620033)

摘　　要：目的:对比重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗心源性脑梗死及非心源性脑梗死的疗效及安全性。方法:回顾性分析超急性期脑梗死患者86例,其中心源性脑梗死溶栓组(CE组)30例和非心源性脑梗死溶栓组(NCE组)56例。比较两组治疗前、后(2、24 h、7 d)的NIHSS评分和治疗前后的m RS评分(7 d、90 d)及两组的不良事件的发生率。结果:CE组和NCE组治疗后7 d的NIHSS评分均较治疗前有统计学差异(P<0.05),两组比较治疗前后各时间点NIHSS、m RS评分及90 d预后良好比率均无统计学差异(P>0.05);CE组溶栓后症状性脑出血、非症状性脑出血发生率、病死率稍高于NCE组,差异无统计学意义(P>0.05),CE组皮肤黏膜出血发生率、脑疝发生率高于NCE组,差异有统计学意义(P<0.05)。结论:对于心源性脑梗死,4.5 h内静脉溶栓能有效地改善患者的神经功能缺损和预后,且总体疗效和预后与非心源性脑梗死相当,但心源性脑梗死患者溶栓后出血风险和严重不良事件发生率有所增加。在谨慎选择静脉溶栓方案的同时应该充分评估风险和预后。Objective To compare the efficacy and safety of intravenous thrombolysis on cardiogenic cerebral infarction and noncardiac infarction by recombinant tissue plasminogen activator （rt-PA）. Methods Comparations of NIHSS, mRS and adverse events before and after treatment were made between the cardiogenic group and the noncardiac group. Results No significant differences in the NIHSS and mRS were found between the two groups. The incidence of brain hernia and dermatorrhagia in the cardiogenic group was higher than that in the noncardiac group. Conchmion Rt-PA therapy in cardiogenic cerebral infarction was effective and safe in spite of higher incidence of hemorrhage and brain hernia.

关 键 词：脑梗死 重组组织型纤溶酶原激活剂 静脉溶栓 心源性脑梗死 非心源性脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]