轻型缺血性卒中TOAST分型及静脉溶栓的研究  

The study of intravenous thrombolysis for different TOAST subtype of minor ischaemic stroke

作　　者：朱海暴[1] 杨静[1] 沈永玲[1] 齐丽敏[1] 冯丽[1] 张冠文[1] 桑晓一 程瑞年[1] 

机构地区：[1]河北省承德市中心医院神经内科,河北承德067000

出　　处：《中国医药导报》2017年第23期56-59,共4页China Medical Herald

基　　金：河北省承德市科学技术研究与发展计划资助项目(201422001)

摘　　要：目的评测轻型缺血性卒中TOAST各亚型rt-PA静脉溶栓治疗的安全性和短期预后。方法选取承德市中心医院2013年11月~2016年1月收治的256例轻型缺血性卒中患者,其中136例接受rt-PA静脉溶栓(静脉溶栓组),120例接受口服药物治疗(未溶栓组),并对两组患者进行TOAST病因分型。治疗90 d后评测NIHSS评分、改良Rankin量表评分(mRS),其中NIHSS评分0~1分、mRS为0~1分者定义为良好结局,并比较两组患者90 d内脑出血率、死亡率和复发率。结果静脉溶栓组患者良好结局的比例明显高于未溶栓组(P<0.05),复发率明显低于未溶栓组(P<0.05)。其中,大动脉粥样硬化型(LAA)亚组患者接受静脉溶栓良好结局的比例明显高于未溶栓者(P<0.05),其脑梗死复发率明显降低(P<0.05)。结论 rt-PA静脉溶栓治疗可提高轻型缺血性卒中,尤其是LAA型患者90 d内良好结局的比例,减少复发率,安全性可。Objective To analysis safety and short-term prognosis of rt-PA intravenous thrombolysis treatment in dif- ferent TOAST subtype of minor ischaemic stroke. Methods From November 2013 to January 2016, 256 patients with mild ischaemic stroke in Chengde Central Hospital were selected. 136 patients were treated with rt-PA intravenous thrombolysis （intravenous thrombolysis group）, and 120 patients were treated with oral drugs （non thrombolysis group）, the patients in the two groups were divided by TOAST etiology. 90 days after treatment, the scores of NIHSS and mRS, the cerebral hemorrhage rate, death rate, recurrence rate were observed, besides the NIHSS score of 0-1 and mRS of 0-1 were defined as good outcomes. Results The proportion of good outcomes in the intravenous thrombolysis group was higher than that of the non thrombolysis group, the recurrence rate was lower than that of the non thrombolysis group, with statistically significant difference （P 〈 0.05）. And the proportion of good outcomes in the LAA subgroup who were treated with rt-PA intravenous thrombolysis was higher and the recurrence rate was lower （P 〈 0.05）. Conclusion rt- PA intravenous thrombolysis can improve the proportion of good outcomes in the patients with minor ischaemic stroke in 90 days, especially LAA subtype, reduce the recurrence rate, and it has good safety.

关 键 词：轻型缺血性卒中 重组组织型纤溶酶原激活剂 溶栓治疗 TOAST分型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]