rt-PA静脉溶栓与尿激酶静脉溶栓治疗急性脑梗死的疗效比较研究  

Comparative Study of Intravenous Thrombolysis with rt-PA and with Urokinase for Patients of Acute Cerebral Infarction

作　　者：肖静[1] 谭郎敏[1] 潘成德[1] 郑宗菊[1] 鄢宗仁 唐坤裕 唐明山[1] XIAO Jing;TAN Langmin;PAN Chengde;ZHENG Zongju;YAN Zongren;TANG Kunyu;TANG Mingshan(Depamnent of Neurology,the People＇s Hospital of Banan District,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院神经内科,重庆401320

出　　处：《解放军预防医学杂志》2018年第4期441-444,450,共5页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：重庆市科技计划项目(No.科技2015016)

摘　　要：目的比较重组组织型纤溶酶原激活剂(rt-PA)与尿激酶(UK)静脉溶栓对急性脑梗死患者的疗效与安全性。方法于2013年7月至2016年6月选择发病<6 h的急性脑梗死患者116例,随机分为rt-PA(0.6~0.9 mg/kg)治疗组58例与低UK(l万~1.5万IU/kg)治疗组58例,比较两组治疗前和治疗后24 h、7 d的神经功能缺损(NIHSS)评分及日常生活(barthel)指数,以及治疗后7 d与14 d的mRS评分、治疗后24 h急性心肌梗死溶栓分级标准(TIMI)评分,并评价两组的疗效及脑出血发生率。结果治疗后24 h与治疗后7 d,两组的NHISS评分和Barthel评分均无统计学差异(P>0.05);治疗后7d与治疗后14 d,两组的mRS评分无统计学差异(P>0.05);治疗后24 h两组的血管再通情况无统计学差异(P>0.05);治疗后28 d,rt-PA组的总有效率(87.93%)略高于UK组(79.32%),rt-PA组SICH发生率(3.45%)略低于UK组(8.62%),P均>0.05。结论 rt-PA与尿激酶治疗发病6 h之内的急性脑梗死均能取得良好的疗效,前者的安全性略高。Objective To compare the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator（ rt-PA） and with urokinase（ UK） for patients with acute cerebral infarction. Methods One hundred and sixteen patients of acute cerebral infarction treated within 6 hours of onset of the disease between July 2013 and June 2016 were selected and randomly divided into rt-PA（ dosage： 0.6-0.9 mg/kg） group（ 58 cases） and UK（ dosage： 10-1.5 thoudsand IU/kg） group（ 58 cases）. The NIHSS scores and barthel indexes before treatment and 24 h,7 days after treatment,mRS scores 7 days,14 days after treatment,and TIMI scores 24 hours after treatment were compared between the two groups. The efficacy and rate of cerebral hemorrhage were observed. Results The difference of NIHSS scores and barthel indexes at 24 hours and 7 days after treatment was not statistically significant between the two groups（ P〈0.05）,neither was the difference of mRS scores 7 days and14 days after treatment（ P〈0.05）. The difference of TIMI scores 24 hours after treatment between the two groups was not statistically significant（ P〈0.05）. The total effective rate in the rt-PA group was 87.93%,which was higher than that of the UK group（ 79.32%）（ P〈0.05）. The rate of SICH in the rt-PA group（ 3.45%） was lower than that of the UK group（ 8.62%）（ P〈0.05）.Conclusion Intravenous thrombolysis with rt-PA and with UK for treating patients of acute cerebral infarction within 6 hours of onset can both achieve good efficacy,but rt-PA is safer.

关 键 词：脑梗死 静脉溶栓 重组组织型纤溶酶原激活剂 尿激酶 疗效 

分 类 号：R743.33[医药卫生—神经病学与精神病学]