重组组织型纤溶酶原激活剂静脉溶栓治疗心源性与非心源性脑梗死的疗效及安全性对比  

Comparison of Efficacy and Safety of Recombinant Tissue Plasminogen Activator in Intravenous Thrombolysis for Cardiogenic and Non-cardiogenic Cerebral Infarction

作　　者：曹莉[1] 张玉琴 王雷[1] 汪梦琳 CAO Li(Anqing Hospital Affiliated to Anhui Medical University, Anhui Anqing 246000, China)

机构地区：[1]安徽医科大学附属安庆医院神经内科,安徽安庆246000 [2]安徽省第二人民医院神经内科,安徽安庆246000

出　　处：《河北医学》2019年第12期1954-1957,共4页Hebei Medicine

基　　金：安徽省安庆市科技局科研项目,(编号:2018Z2009)

摘　　要：目的:比较重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗心源性脑梗死(CCI)与非心源性脑梗死(NCI)的疗效及安全性。方法:采用回顾性研究,收集2017年1月至2018年12月本院60例行rt-PA静脉溶栓治疗超急性期脑梗死患者的临床资料,分为NCI组(24例)和CCI组(36例)。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分和不良事件发生情况的差异。结果:相比治疗前,两组治疗后NIHSS量表评分均显著下降(P<0.01);CCI组治疗前、治疗后1d和治疗7d时NIHSS量表评分与NCI组比较,均无统计学意义(P>0.05)。两组治疗后mRS量表评分较治疗前均显著下降(P<0.01);CCI组治疗前、治疗后1个月和治疗后3个月mRS量表与NCI组比较,均无统计学意义(P>0.05)。两组患者治疗后3个月预后状况的比较,并无明显差异(P>0.05)。两组再梗死、非症状性脑出血、症状性脑出血和死亡率比较,均无统计学意义(P>0.05);CCI组皮肤黏膜出血和脑疝发生率显著高于NCI组(P<0.05)。结论:超急性期CCI和NCI患者于4.5h内行rt-PA静脉溶栓治疗均可有效减轻神经功能缺损,有效患者预后状况,二者总体疗效和预后效果相当,但CCI患者溶栓后发生出血和不良事件的风险性明显升高。Objective: To compare the efficacy and safety of recombinant tissue plasminogen activator(rt-PA) in intravenous thrombolysis for cardiogenic cerebral infarction(CCI) and non-cardiogenic cerebral infarction(NCI). Methods: Retrospective study was conducted to collect the clinical data of 60 patients with hyperacute cerebral infarction treated by rt-PA intravenous thrombolysis from January 2017 to December 2018 in our hospital, and they were divided into NCI group(24 cases) and CCI group(36 cases). The differences of National Institutes of Health Stroke Scale(NIHSS) and modified Rankin scale(mRS) scores and adverse events before and after treatment were compared between the two groups. Results: Compared with before treatment, NIHSS scale scores of both groups were significantly decreased after treatment(P<0.01). The NIHSS scale scores of CCI group before, 1 day after and 7 days after treatment were not statistically significant compared with those of NCI group(P>0.05). After treatment, mRS scale scores of the two groups were significantly lower than before treatment(P<0.01). There was no significant difference in mRS scale between CCI group and NCI group before, 1 month after and 3 months after treatment(P>0.05). There was no significant difference between the two groups in the prognosis at 3 months after treatment(P>0.05). There was no statistical significance in the comparison of reinfarction, asymptomatic cerebral hemorrhage, symptomatic cerebral hemorrhage and mortality between the two groups(P>0.05). The incidence of skin mucosal bleeding and brain hernia in CCI group was significantly higher than that in NCI group(P<0.05). Conclusions: Rt-pa intravenous thrombolytic therapy in hyperacute CCI and NCI patients within 4.5 h can effectively alleviate neurological defects, and the prognosis of patients is effective. The overall efficacy and prognosis effect of the two are similar, but the risk of bleeding and adverse events after thrombolysis in CCI patients is significantly increased.

关 键 词：心源性脑梗死 非心源性脑梗死 重组组织型纤溶酶原激活剂 静脉溶栓 

分 类 号：R74[医药卫生—神经病学与精神病学]