伴心房颤动的急性脑梗死不同时间窗行重组组织型纤溶酶原激活剂静脉溶栓治疗的疗效观察  

Effect of intravenous thrombolysis with recombinant tissue type plasminogen activator （rt-PA） in different time windows on acute cerebral infarction patients with atrial fibrillation

作　　者：郭岩[1] 张翠宏 王海洋[1] 林亚楠[1] 王玉[1] 孙晓培[1] 

机构地区：[1]大连医科大学附属第一医院神经内科,116011

出　　处：《中华医学杂志》2016年第26期2054-2058,共5页National Medical Journal of China

摘　　要：目的观察伴心房颤动（简称房颤）的急性脑梗死患者不同时间窗行重组组织型纤溶酶原激活剂（rt－PA）静脉溶栓治疗的疗效。方法收集2012年1月至2015年12月伴有房颤并接受rt－PA静脉溶栓治疗的急性脑梗死患者，按发病至开始溶栓时间分为〈3 h溶栓组和3～4.5 h溶栓组；采用美国国立卫生研究院卒中量表（NIHSS）和改良的Rankin量表（mRS）评估其早期疗效及远期预后；观察比较两组出血性梗死（HI）、脑实质出血（PH）、症状性脑出血（sICH）发生率。结果共103例患者纳入研究，其中〈3 h溶栓组48例，3～4.5 h溶栓组55例。与溶栓前相比，两组溶栓后24 h、7 d NIHSS评分均降低，差异具有统计学意义。组间比较，〈3 h溶栓组24 h临床疗效优于3～4.5 h溶栓组，差异有统计学意义（P〈0.05），两组患者7 d、90 d预后比较差异均无统计学意义（均P〉0.05）。〈3 h溶栓组和3～4.5 h溶栓组PH型出血发生率为8.3%（4/48）和21.8%（12/55），两者差异具有统计学意义（P〈0.05）；HI型出血和sICH发生率分别为18.8%（9/48）和32.7%（18/55）、8.3%（4/48）和14.5%（8/55），差异均无统计学意义（均P〉0.05）。结论伴房颤的急性脑梗死患者早期3 h内行rt－PA静脉溶栓有助于短期内神经功能改善；3～4.5 h溶栓虽然可增加PH型出血风险，但并不增加症状性颅内出血发生率；两组患者90 d临床预后无差异，提示对于伴房颤的脑梗死患者3～4.5 h溶栓是安全有效的。Objectives To observe the intravenous thrombolysis effect of rt-PA in different time windows of acute cerebral infarction with atrial fibrillation （AF）. Methods Acute cerebral infarction patients who accepted the intravenous thrombolysis treatment with AF from January 2012 to December 2015 were included. According to the time from onset to intravenous thrombolysis, patients were divided into two groups： thrombolysis within 3 h and thrombolysis between 3 -4. 5 h. The Nation Institutes of Health Stroke Scale （NIHSS） and modified Rankin Scale （mRS） were used to evaluate early and long-time therapeutic effects. The incidence of hemorrhagic infarction （HI）, parenehymal hemorrhage （PH） and symptomatic intraeranial hemorrhage（slCH） after thrombolysis within 24 hours were observed in the two groups. Results A total of 103 patients were included in the study,with 48 cases in thrombolysis within 3 h group and 55 cases in thrombolysis between 3 -4. 5 h group. After thrombolysis treatment, the 24-hour and 7-day NIHSS score of the two groups were significant lower than before treatment, and the difference was statistically significant（ P 〈 0. 05 ）. Compared between groups, 24-hour clinical efficacy of thrombolysis within 3 h group was better than that of thrombolysis between 3 -4. 5 h group, and the differenee was statistically significant （ P 〈 0. 05 ）. There were no statistically significant differences between these two groups about 7-day and 90- day prognosis（ P 〈 0. 05 ）. The rate of PH in thrombolysis within 3 h group and thrombolysis between 3 -4. 5 h group is 6. 3% （3/48） and 21.8% （ 12/55 ） individually, and the difference was statistically significant （ P 〈 0. 05）. While no statistically significant differences was found about the rate of HI（ 18.8% vs 32. 7% , P 〉 0. 05） and sICH（8.3 % vs 14. 5 %, P 〉 0. 05） between these two groups. Conclusions For patients of acute cerebral infarction with AF, intravenous thrombolytic therapy by rt-PA within 3 h

关 键 词：脑梗死 溶栓治疗 时间窗 心房颤动 重组组织型纤溶酶原激活剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]