前后循环急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的临床疗效比较  

Curative effect of intravenous rt-PA thrombolysis on anterior and posterior circulation acute ischemic stroke

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

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

出　　处：《中华老年心脑血管病杂志》2016年第4期398-400,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨前、后循环急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的临床疗效及相关影响因素。方法回顾性分析接受rt-PA静脉溶栓治疗的178例急性脑梗死患者的临床资料,其中前循环脑梗死(ACS)138例(ACS组),后循环脑梗死(PCS)40例(PCS组),通过患者入院时及24h美国国立卫生研究院卒中量表(NIHSS)评分,90d改良的Rankin量表(mRS)评分,预后良好率,颅内出血及死亡情况,比较2组的临床疗效。结果 2组患者的给药时间、既往心房颤动史、脑卒中及基线NIHSS评分比较差异有统计学意义(P<0.05)。在临床转归方面,PCS组90dmRS评分和3个月死亡显著高于ACS组[(3.28±1.87)分vs(2.37±1.88)分和20.00%vs 5.80%,P<0.05],预后良好显著低于ACS组(40.00%vs 62.32%,P<0.05)。接受rt-PA溶栓的脑梗死患者的症状性颅内出血与年龄、基线NIHSS评分及24hNIHSS评分呈正相关;90d内死亡与前后循环、24h NIHSS评分呈正相关。结论 rt-PA静脉溶栓患者中ACS临床疗效较PCS相对较好。PCS是急性脑梗死rt-PA静脉溶栓治疗后死亡的危险因素之一。Objective To study the curative effect of intravenous rt-PA thrombolysis on anterior and posterior circulation AIS.Methods Clinical data of 178 AIS patients on intravenous rt-PA thrombolysis were retrospectively analyzed.The patients were divided into anterior circulation AIS group（n=138）and posterior circulation AIS group（n=40）.Their 24 hNIHSS score,90 d mRS score,favorable outcome,intracranial hemorrhage and mortality were recorded.The curative effects of intravenous rt-PA thrombolysis on anterior and posterior circulation AIS were compared.Results The administration time of drugs,history of AF,history of ischemic stroke and baseline NIHSS score differed significantly between the two groups（P〈0.05）.The 90 d mRS score and the 3-mobth mortality were significantly higher whereas the favorable outcome rate was significantly lower in posterior circulation AIS group than in anterior circulation AIS group（3.28±1.87 vs 2.37±1.88,20.00%vs 5.80%,P〈0.05;40.00%vs 62.32%,P〈0.05）.Symptomatic intracranial hemorrhage was positively related with age,baseline and 24 hNIHSS score while the 90 dmortality was positively related with anterior and posterior circulation,24 hNIHSS score in ischemic stroke patients on intravenous rt-PA throbolysis.Conclusion The curative effect of intravenous rt-PA thrombolysis is better on anterior circulation AIS than on posterior circulation AIS.Posterior circulation AIS is one of the independent risk factors for mortality of acute ischemic stroke patients on intravenous rt-PA thrombolysis.

关 键 词：脑梗死 组织型纤溶酶原激活物 血栓溶解疗法 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]