不同时间窗不同剂量阿替普酶治疗急性脑梗死的预后和安全性分析  

Analysis of the prognosis and safety of alteplase when administered in different time windows or with different doses in the treatment of acute cerebral infarction

作　　者：李克良[1] 耿直[2] LI Keliang;GENG Zhi(Department of Neurology,Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200336,China;Department of Neurology,the Sixth People‘s Hospital,Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属同仁医院神经内科,上海200336 [2]上海交通大学附属第六人民医院神经内科,上海200233

出　　处：《现代仪器与医疗》2018年第2期24-27,共4页Modern Instruments & Medical Treatment

摘　　要：目的 :研究不同时间窗不同剂量阿替普酶治疗急性脑梗死的预后和安全性。方法 :回顾性分析2010年5月至2016年8月接受阿替普酶(rt-PA)静脉溶栓治疗的212例急性脑梗死患者的临床数据,按照发病时间窗、治疗方法不同分为4组,治疗后90d以改良Rankin量表(m RS)评分评价预后,统计治疗后24h脑出血发生率和治疗后90d死亡率,比较4组的预后和安全性。结果 :A、C组预后良好率分别为76.4%,46.6%,差异有统计学意义(P=0.001)。B、D组预后良好率分别为96.1%,72.9%,差异有统计学意义(P=0.001)。A、B组之间,C、D组之间的预后良好率差异均有统计学意义(P=0.004,P=0.006)。A组脑出血发生率1.8%,死亡率5.5%,均低于C组(17.2%,10.3%),A组与C组脑出血率差异有统计学意义(P=0.006),死亡率无显著差异。B组脑出血发生率3.9%,死亡率为2.0%,均低于D组(22.9%,14.6%),B组和D组脑出血率差异有统计学意义(P=0.005),死亡率差异无统计学意义。A、B组之间,C、D组之间脑出血发生率及死亡率均无统计学差异。结论 :rt-PA使用剂量相同的情况下,治疗的时间窗越短,预后情况越好。发病时间窗相同的情况下,标准剂量rt-PA治疗的预后情况要明显优于低剂量rt-PA。治疗剂量相同的情况下,静脉溶栓的时间窗越短,治疗安全性越高。发病后治疗时间相同的情况下,标准剂量rt-PA的安全性与低剂量rt-PA的安全性无显著差异。Objective:The article aim was to study the prognosis and safety of acute cerebral infarction treated with different doses of alteplase in different time windows.Methods:The clinical data of 212 cases of acute cerebral infarction accepted intravenous thrombolytic therapy of alteplase from May 2010 to August 2016 in our hospital were retrospectively analysis.212 patients were divided into four groups according to the time window from symptom onset to IV alteplase injection and treatment method.The mRS scores of the four groups were evaluated at 90 days after administration of alteplase to evaluate the prognosis of the four groups.The incidence of intracerebral hemorrhage at the time of 24 hours and the mortality within 90 days after administration of alteplase were evaluated to evaluate the safety of different treatment regimens.Results:The mRS score results show that favorable functional outcome of group A and C was 76.4%and 46.6%respectively,the difference was statistically significant(P=0.001).The favorable functional outcome of group B and D was 96.1%and 72.9%respectively,the difference was statistically significant(P=0.001).There were significant differences in the favorable functional outcome of group A and group B,group C and group D respectively(P=0.004,P=0.006).The incidence of intracerebral hemorrhage in group A was 1.8%,the mortality was 5.5%,which were lower than that in group C(17.2%,10.3%).The difference in the incidence of intracerebral hemorrhage between the two groups was statistically significant(P=0.006).There was no significant difference in mortality between the two groups.The incidence of intracerebral hemorrhage in group B was 3.9%,the mortality was 2.0%,which were lower than that in group D(22.9%,14.6%),The difference in the incidence of intracerebral hemorrhage between the two groups was statistically significant(P=0.005).There was no significant difference in mortality between the two groups.There were not significant differences in the incidence of intracerebral hemorrhage and mortality b

关 键 词：剂量rt-PA的安全性无显著差异.[关键词] 

分 类 号：R743.3[医药卫生—神经病学与精神病学]