轻型卒中患者行重组组织型纤溶酶原激活剂静脉溶栓治疗的疗效观察  

Clinical efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator on patients with minor ischemic stroke

作　　者：石少亭[1] 王林[1] 柏玉兰 李军朝[1] 张蓓[1] SHI Shaoting, WANG Lin, BAI Yulan, LI Junchao, ZHANG Bei(Department of Neurology, the First Affiliated Hospital of Xi＇an Medical College, Xi＇an 710077, Shaanxi Province, Chin)

机构地区：[1]西安医学院第一附属医院神经内科,陕西西安710077

出　　处：《解放军医学院学报》2018年第3期196-199,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨轻型卒中(minor ischemic stroke,MIS)患者行重组组织型纤溶酶原激活剂(recombinant tissue Plasminogen Activator,rt-PA)静脉溶栓治疗的安全性和有效性。方法连续纳入2015年1月-2017年3月由卒中绿色通道收入我院的静脉溶栓时间窗(4.5 h)内的轻型卒中患者112例,分为3组:0~3 h静脉溶栓组(14例)、3~4.5 h静脉溶栓组(32例)和非静脉溶栓组(66例)。溶栓组用rt-PA进行静脉溶栓治疗,24 h后予以阿司匹林+氯吡格雷的双联抗血小板聚集治疗;非静脉溶栓组首剂予以氯吡格雷300 mg,24 h内再予以双联抗血小板聚集治疗。所有患者均在入院时行美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分,3个月后行NIHSS评分和改良Rankin量表(modified rankin scale,m RS)评分。结果 3组患者入院时NIHSS评分,3个月后NIHSS评分及m RS评分均无统计学差异;3个月内缺血性卒中复发情况比较,静脉溶栓组2例复发,非静脉溶栓组12例复发,差异有统计学意义(P<0.05)。结论发病0~3 h和3~4.5 h静脉溶栓治疗效果相当;与未静脉溶栓患者相比,静脉溶栓患者并未显著提高良好预后率;静脉溶栓治疗可能降低3个月内缺血性卒中复发率。Objective To explore the clinical efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） on patients with acute minor ischemic stroke （MIS）. Methods One hundred and twelve patients who were diagnosed as MIS and admitted to our hospital within the time window of intravenous thrombolysis （4.5 h） from January 2015 to March 2017 were recruited in our study. These patients were then divided into three groups： intravenous thrombolysis within 0-3 h （n=14）, intravenous thrombolysis within 3-4.5 h （n=32） and without intravenous thrombolysis （n=66）. Patients in intravenous thrombolysis groups received the rt-PA therapy, and then were treated with dual anti-platelet therapy by aspirin and clopidogrel within 24 hours. Patients in without intravenous thrombolysis group received 300 mg clopidogrel therapy, and then were treated with dual anti-platelet therapy by aspirin and clopidogrel within 24 hours. All the patients had received NIHSS scoring at admission, and then received NIHSS and mRS scoring after 3 months as well. Results There was no statistical difference in the NIHSS score at admission, and in the NIHSS and mRS score at 3 months between three groups within 3 months, acute ischemic stroke recurred in 2 cases in intravenous thrombolysis group, and 12 cases in without intravenous thrombolysis group, with statistically significant difference. Conclusion The clinical efficacy of intravenous thrombolysis within 0-3 h and within 3-4.5 h has no difference. Compared with patients without receiving intravenous thrombolysis therapy, patients receiving intravenous thrombolysis therapy do not acquire better prognosis, but it may reduce the recurrence rate of ischemic stroke within 3 months.

关 键 词：轻型卒中 静脉溶栓 NIHSS评分 缺血性卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]