rt-PA溶栓时机对急性缺血性脑卒中伴心房颤动患者的溶栓效果及安全性的影响  

The influence of thrombolytic timing of rt-PA on thrombolytic effect and safety of patients with acute ischemic stroke combined with atrial fibrillation

作　　者：于红梅 史晴晴 陈颖 张洁 Yu Hongmei;Shi Qingqing;Chen Ying(Department of Neurology,Hebei Province Lang fang City Fourth People＇s Hospital,Langy ang Hebei 06570)

机构地区：[1]河北省廊坊市第四人民医院神经内科,065700

出　　处：《卒中与神经疾病》2018年第5期521-524,共4页Stroke and Nervous Diseases

摘　　要：目的探讨rt-PA溶栓时机对急性缺血性脑卒中伴心房颤动患者的溶栓效果及安全性的影响。方法选取本院2015年4月-2017年8月收治急性缺血性脑卒中伴心房颤动患者共124例,其中发病后3～4.5h行rt-PA溶栓共64例设为对照组,发病后3h内行rt-PA溶栓共60例设为观察组;比较2组患者溶栓有效率、治疗前后NIHSS评分、随访mRS评分及严重出血事件发生率。结果观察组患者溶栓有效率显著高于对照组(P<0.05);2组患者治疗后1和7dNIHSS评分均显著低于治疗前(P<0.05);观察组患者治疗后1dNIHSS评分显著低于对照组(P<0.05);2组患者治疗后7dNIHSS评分比较差异无显著性(P>0.05);2组患者随访mRS评分分级情况比较差异无显著性(P>0.05);2组患者出血性脑梗死和脑部症状性出血发生率比较差异无显著性(P>0.05);观察组患者治疗后脑实质出血发生率显著低于对照组(P<0.05)。结论急性缺血性脑卒中伴心房颤动患者在发病后3h内行rt-PA溶栓在可提高溶栓效果和促进受损神经功能恢复方面较发病后3～4.5h溶栓具有明显优势,但在远期疗效和严重出血事件发生风险方面两者接近。Objective To investigate the influence of thrombolytic timing of rt-PA on thrombolytic effect and safety of patients with acute ischemic stroke combined with atrial fibrillation.Methods 124 patients with acute cerebral infarction combined with atrial fibrillatio were chosen in the period from April 2015 to August 2017 in our hospital and divided into both group according to treatment timing,control group（64 patients）were treated with rt-PA for 3～4.5 hafter morbidity and observation group（60 patients）were treated with rtPA for3 hafter morbidity,and the thrombolysis effective rate after operation,NIHSS scores before and after treatment,mRS scores with follow-up and serious bleeding events incidence of both groups were compared.Results The thrombolysis effective rate of observation group after thrombolytic treatment was significantly higher than that of control group（P〈0.05）.The NIHSS scores in 1 dand 7 dafter treatment of both groups were significantly lower than those before treatment（P〈0.05）.The NIHSS scores of observation group in 1 dafter treatment were significantly lower than those of control group（P〈0.05）.There was no significant difference in the NIHSS scores in 7 dafter treatment between 2 groups（P〈0.05）There was no significant difference in the mRS scores with follow-up between 2 groups（P〉0.05）.There was no significant difference in the incidence of hemorrhagic infarction and symptomatic intracerebral hemorrhage between 2 groups（P〉0.05）.The incidence of cerebral parenchyma hemorrhage of observation group was significantly lower than that of control group（P〉0.05）.Conclusion Compared with rt-PA for 3～4.5 h,rt-PA for〈3 hafter morbidity in the treatment of patients with acute cerebral infarction combined with atrial fibrillation possessed the advantages including higher the thrombolytic effects and promoted the damaged nerve function recovery and had the same in the clinical effects for long term and the bleeding events risk.

关 键 词：RT-PA 急性缺血性脑卒中 心房颤动 溶栓时机 

分 类 号：R743.3[医药卫生—神经病学与精神病学]