NIHSS评分≥15分且发病时间≤4.5h的重型脑梗死患者静脉溶栓的疗效观察  

Curative effect of recombinant tissue plasminogen activator in acute ischemic stroke patients in more than15 points of NIHSS scores and less than 4.5h in onset time

作　　者：童艳飞 张佩兰[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市环湖医院,300060

出　　处：《实用医学杂志》2016年第5期812-815,共4页The Journal of Practical Medicine

基　　金：天津市科委科技支撑计划项目(编号:13ZCZDSY01600)

摘　　要：目的:探讨发病时间≤4.5 h且美国国立卫生研究院卒中量表(NIHSS)评分≥15分的重型脑梗死患者静脉使用重组组织型纤溶酶原激活剂(阿替普酶)治疗的有效性及安全性。方法:收集发病时间≤4.5 h且入院时NIHSS评分≥15分的重型脑梗死患者127例,将68例接受阿替普酶静脉溶栓治疗的患者作为治疗组,59例不接受阿替普酶静脉溶栓治疗的患者作为对照组,观察两组脑出血的发生率、病死率。治疗前和治疗后7、30 d通过NIHSS评分评估患者的神经功能缺损程度,治疗后90 d时应用改良的Rankin量表(m RS)评估患者综合生活能力。结果:两组治疗后的NIHSS评分较治疗前显著降低,差异有统计学意义(P<0.05),且治疗组治疗后7、30 d的NIHSS评分较对照组低,差异有统计学意义(P<0.05)。两组治疗后90 d的m RS评分比较,差异有统计学意义(P<0.05),治疗组脑出血的发生率和病死率较对照组高,但差异无统计学意义(1.5%vs 0%,7.5%vs 5.1%,P>0.05)。结论:NIHSS评分≥15分且发病时间≤4.5 h的重型脑梗死患者使用阿替普酶静脉溶栓治疗是安全、有效的。Objective To observe the curative effect and safety of recombinant tissue plasminogen acti- vator （rt-PA） in acute ischemic stroke （AIS） patients in more than 15 points of NIHSS scores and less than 4.5 h in onset time. Methods One hundred and twenty-seven cases with AIS in more than 15 points of NIHSS scores and less than 4.5 h in onset time were included into the study. According to the patients＇ option to accept the intravenous thrombolytic therapy, 68 patients received intravenous thrombolysis with aheplase as the treat- ment group, 59 patients did not receive intravenous thrombolytic therapy as the control group. The incidence of intracerebral hemorrhage and mortality were observed in the two groups after thrombolytic therapy. Their nerve function defect was scored according to the NIHSS scores before and after treatment at day 7 and day 30. Their living ability was assessed by mRS in modified Rankin chart after the treatment at the day 90. Results The NIHSS scores were significant lower in the 2 groups after therapy （P 〈 0.05）. The NIHSS scores at each time point and mRS scores in the treatment group were lower than the control group （P 〈 0.05 ）. No significant differ-nce was found in the incidence of intracerebral hemorrhage and mortality between the 2 groups, although these were higher in the treatment group than in control group （1.5% vs 0%, 7.5% vs 5.1%, P 〉 0.05）. Conclusion Intravenous rt-PA thrombolytic therapy is effective and safe for AIS whose NIHSS scores are more than 15 points and onset time are less than 4.5 h.

关 键 词：脑梗死 NIHSS评分 重组组织型纤溶酶原激活剂 阿替普酶 

分 类 号：R743.3[医药卫生—神经病学与精神病学]