溶栓模式对急性缺血性脑卒中静脉溶栓DNT的影响及效果分析  

Effect of thrombolytic therapy on intravenous thrombolytic therapy of DNT in acute ischemic stroke and its effect analysis

作　　者：张重阳[1] 王耀辉[1] 刘宇鹏[1] 刘维斌[1] 孙伟[1] 张鑫宇[1] 何焰鹏[1] Zhang Chongyang;Wang Yaohui;Liu Yupeng;Liu Weibin;Sun Wei;Zhang Xinyu;He Yanpeng(Department of Emergency,The First Hospital of Qinhuangdao ,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院急诊科,066000

出　　处：《中华急诊医学杂志》2019年第6期755-759,共5页Chinese Journal of Emergency Medicine

基　　金：河北省重点研发计划自筹项目(172777202).

摘　　要：目的分析急诊溶栓模式对急性缺血性脑卒中(AIS)患者入院-溶栓时间(DNT)的影响及效果。方法选取2015年5月至2017年6月秦皇岛市第一医院行静脉内溶栓的AIS患者182例。会诊溶栓组83例,为2015年5月至2016年5月经神经内科会诊后行静脉内溶栓的患者;急诊溶栓组99例,为2016年6月至2017年6月经急诊溶栓小组于急诊科行静脉内溶栓的患者。比较两组DNT,溶栓24 h症状性出血转化率,溶栓24 h、7 d美国国立卫生研究院卒中量表(NIHSS)评分,溶栓7 d和溶栓3个月病死率及溶栓3个月改良Rankin评分(mRs)。结果两组资料基线特征差异无统计学意义(P>0.05)。与会诊组比较,急诊溶栓组DNT[(69.77±11.66)min比(80.12±15.49)min,t=5.745,P<0.01]明显缩短,治疗3个月评分良好率[39(39.4%)比21(25.3%),χ^2=4.272,P=0.039]明显增高,差异有统计学意义(P<0.05);治疗24 h颅内出血转化率[12(12.12%)比5(6.02%),χ^2=1.982,P=0.159]、治疗7 d病死率[10(10.10%)比6(7.22%),χ^2=0.464,P=0.496]、治疗3个月病死率[14(14.14%)比11(13.25%),χ^2=0.030,P=0.862]、治疗24 h有效率[57(57.6%)比53(63.8%),χ^2=0.745,P=0.388]、治疗7 d有效率[50(50.5%)比46(55.4%),χ^2=0.438,P=0.508]结果比较差异无统计学意义(P>0.05)。结论急诊溶栓模式可缩短AIS患者rt-PA静脉溶栓治疗的DNT,其安全性及效果与神经科会诊模式相比无差异,且可以提高预后良好率。Objective Analyze the effect of emergency thrombolytic therapy on door to needle time (DNT) in patients with acute ischemic stroke (AIS) and effect. Method Selected 182 cases of AIS patients underwent intravenous thrombolysis at the First Hospital of Qinhuangdao from May 2015 to June 2017 . Thrombolytic therapy group (83 cases), for the May 2015-May 2016 after neurological consultation intravenous thrombolysis patients;Emergency thrombolytic group(99 cases), for the June 2016-June 2017 emergency thrombolysis group Emergency Department of intravenous thrombolysis patients. Compare the two groups of DNT, thrombolytic therapy 24 h symptomatic hemorrhage conversion rate, Thrombolysis 24 h, 7 dNIHSS score, 7 dthrombolysis and 3 months thrombolysis and thrombolysis 3 months improved Rankin score (mRs). Results There was no significant difference in baseline characteristics between the two groups (P>0.05).Compared with the consultation group, the DNT[(69.77±11.66)min vs (80.12±15.49) min, t=5.745, P<0.01] of emergency thrombolytic group was significantly shortened, and the good score[39(39.4%) vs 21(25.3%),χ^2=4.272, P=0.039] at 3 months after treatment was significantly higher (P<0.05);Treatment of 24 h intracranial hemorrhage conversion rate[12(12.12%) vs 5(6.02%),χ^2=1.982, P=0.159]、Treatment 7d mortality rate [10(10.10%) vs 6(7.22%),χ^2=0.464, P=0.496], 3 months mortality rate [14(14.14%) vs 11(13.25%),χ^2=0.030, P=0.862]、There was no significant difference in the 24h effective rate [57(57.6%) vs 53(63.8%),χ^2=0.745, P=0.388] and 7d effective rate [50(50.5%) vs 46(55.4%),χ^2=0.438, P0.508] after treatment (P>0.05). Conclusions The emergency thrombolytic model can shorten the DNT of rt-PA intravenous thrombolysis in patients with AIS. The safety and efficacy of DNT are not different from the neurological consultation mode, and can improve the good prognosis rate.

关 键 词：急性缺血性脑卒中 血栓溶解疗法 急诊溶栓 入院至静脉溶栓时间 出血转化 安全性 治疗效果 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]