急性脑梗死合并心房颤动患者的重组组织型纤溶酶原激活剂静脉溶栓治疗  

Treatment effectiveness of intravenous rt-PA thrombolytie therapy in patients with acute cerebral infarction combined with atrial fibrillation

作　　者：李晓波[1] 黄敏[2] 陈蓓蕾[1] 陈兰兰[1] 景坚[1] 李军[1] 袁成林[1] 徐俊[1] 

机构地区：[1]江苏省苏北人民医院神经内科,225001 [2]扬州大学医学院,扬州225001

出　　处：《中华老年医学杂志》2016年第1期22-26,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨急性脑梗死合并心房颤动（房颤）患者重组组织型纤溶酶原激活剂（rt—PA）静脉溶栓治疗的疗效及其相关影响因素。方法选择发病〈4．5h的急性脑梗死合并房颤患者87例，分为rtPA静脉溶栓治疗组46例（溶栓组）和非rt—PA静脉溶栓治疗组41例（非溶栓组）。比较两组治疗前后美周围立卫生研究院脑卒中量表（NIHSS）评分的变化、颅内出血转化情况及病死率；并按病情及发病到治疗时间进行亚组分析。利用Logistic回归分析预后良好的相关因素。结果两组的24h、14d的NIHSS评分差异无统计学意义，但溶栓组的24h、14d的NIHSS评分改善较非溶栓组显著（P〈0．05）。治疗90d后，溶栓组的预后良好率明显高于非溶栓组（43．5％比19．5％，P=0．017），颅内出血转化率高于非溶栓组，但病死率差异无统计学意义。亚组分析显示：NIHSS≤10分的亚组患者和溶栓时间〉3h的亚组患者，溶栓对预后无明显影响；NIHSS〉10分的患者，溶栓组24h及14d的NIHSS评分及90d改良Rankin量表（mRS）评分较非溶栓组显著下降（P〈0．05）；溶栓时间≤3h的患者溶栓组90d的预后良好率明显优于未溶栓组。Logistic分析结果显示，预后良好与人院时NIHSS评分低及溶栓治疗显著相关。结论rt—PA静脉溶栓治疗能显著改善脑梗死合并房颤患者症状，其中症状重（NIHSS〉10分），溶栓时间≤3h的患者从中获益较多。人院时NIHSS分值低和接受rt—PA静脉溶栓治疗是急性脑梗死良好预后的独立预测因素。Objective To investigate the effect of intravenous rt PA thrombolytic therapy on acute cerebral infarction combined with atrial fibrillation and its related factors. Methods A total of 87 patients with （ 4.5 h of symptom onset of acute cerebral infarction combined with atrial fibrillation were enrolled, and divided into rt-PA thrombolytic therapy group （thrombolysis group, n= 46） and nowrt-PA thrombolytic therapy group （non-thrombolysis group, n = 41）. The National Institutes of Health Stroke Scale （NIHSS） score, intracranial bleeding sequelae and mortality were respectively compared before versus after treatment. Patients were sub grouped and analyzed according to the severity of the disease （NIHSS ≤ 10 and NIHSS 2〉 10） and time from onset to treatment （0 3 h and 3.0-4.5 h） . Related factors for good outcome were identified by Logistic regression analysis. Results There were no statistical differences in the NIHSS score at 24 h versus 14 d between the two groups, but the improvement of NIHSS score at 24 h and 14 d was more in thrombolysis group than in non-thrombolysis group （P〈0.05）. The percentage of patients with good outcome was higher in thrombolysis group than in nowthrombolysis group after 90 days of treatment （43.5% vs. 19.5%, P=0. 017）. The improvement rate of intracranial hemorrhage was higher in thrombolysis group than in non thrombolysis group, while there was on significant difference in mortality rate between the two groups. Subgroup analysis showed that for patients with NIHSS ≤10 in admission and patients receiving thrombolysis 〉3 h after onset, intravenous rt-PA thrombolytic therapy had no significant effect on the outcome; for patients with NIHSS 2〉 10 at admission, the N1HSS score at 24 h and 14 d, and the Rankin score （mRS） at 90 days were lower in thrombolysis group than in non-thrombolysis group （both P〈0.05） ; for patients with rt-PA thrombolytic therapy within 3 h after onset, a better prognosis rate at the 90 days after treatment was hi

关 键 词：脑梗死 心房纤颤 溶栓治疗 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] R541.75[医药卫生—临床医学]