不同时间窗阿替普酶治疗心房颤动合并脑梗死效果分析  

作　　者：徐宾[1] 刘新黎[1] 郑水红[1] 

机构地区：[1]浙江中医药大学附属金华中医医院,321017

出　　处：《浙江临床医学》2019年第8期1120-1122,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析阿替普酶治疗心房颤动合并脑梗死的效果及时间窗的选择.方法采用前瞻性研究法,将本院脑梗死患者128例根据有无心房颤动分为心房颤动组和无心房颤动组,均给予阿替普酶治疗,比较两组各时间段神经功能评分(NIHSS)分值降低情况,比较两组静脉溶栓治疗后90d内预后情况.根据时间窗不同,将心房颤动组患者分为A组(发病至溶栓时间为0~3h)和B组(发病至溶栓时间为3~4.5h),比较两组溶栓前,溶栓后1h、24h及7d时NIHSS分值,比较两组静脉溶栓后90d内预后情况.比较心房颤动与无心房颤动组不良反应发生情况.结果心房颤动组与无心房颤动组溶栓后1h、24h、7d时NIHSS分值比较,P均>0.05;心房颤动mRs 0~1分比率低于无心房颤动组,颅内出血转化率高于无心房颤动组,P均<0.05.A组与B组各时间点NIHSS分值比较,P>0.05,7d时两组NIHSS分值均降低,P<0.05;A组溶栓后7dNIHSS降低分值大于B组,P<0.05;A组治疗后90d时mRS 0~1分比率较B组高,症状性颅内出血发生率较B组低,P均<0.05.心房颤动组与无心房颤动组病死率无显著差异,A组与B组病死率无显著差异,P均>0.05.结论阿替普酶可用于心房颤动合并脑梗死患者治疗中,虽然与无心房颤动治疗前比较,该药物用于心房颤动中颅内出血风险更高,但并不增加病死率在发病0~3h内进行阿替普酶静脉溶栓能缓解神经损伤,效果较3~4.5h内溶栓好,且降低了颅内症状性出血风险.Objective To analyze the effect of alteplase in the treatment of atrial fibrillation complicated with cerebral infarction and the choice of time window. Methods A prospective study was conducted to compare the patients with cerebral infarction(128cases)according to the presence or absence of atrial fibrillation into atrial fibrillation group and atrial fibrillation group. All patients were treated with alteplase. The neurological scores of the two groups were compared. The NIHSS score reduction and the prognosis of the two groups after 90 days of intravenous thrombolytic therapy were compared. According to the time window,the patients in the atrial fibrillation group were divided into group A(onset to thrombolysis time was 0~3h) and group B(onset to thrombolysis time was 3~4.5h),and the two groups were compared before thrombolysis and thrombolysis. The NIHSS scores at 1h,24h and 7d were compared and the prognosis was compared within 90 days after intravenous thrombolysis. The incidence of adverse reactions in atrial fibrillation and non-atrial fibrillation were compared. Results The NIHSS scores at 1h,24h,and 7d after atrial fibrillation and atrial fibrillation were compared,P>0.05. Atrial fibrillation mRs 0~1 score was lower than non-atrial fibrillation group. The conversion rate of intracranial hemorrhage was higher than that of non-atrial fibrillation group,P<0.05. The NIHSS scores of group A and group B were compared at different time points. P>0.05, 7d,the NIHSS scores of the two groups were decreased,P<0.05. The 7d NIHSS reduction scores of group A after thrombolysis were greater than group B,P<0.05. Group A on 90 days after treatment,the ratio of mRS 0~1 was higher than that of group B. The incidence of symptomatic intracranial hemorrhage was lower than that of group B,P<0.05. There was no significant difference in mortality between atrial fibrillation group and atrial fibrillation group. There was no significant difference in mortality between group A and group B,P>0.05. Conclusion Alteplase can be used i

关 键 词：阿替普酶 心房颤动 脑梗死 时间窗 神经功能缺损 颅内症状性出血 

分 类 号：R542.22[医药卫生—心血管疾病]