轻型缺血性卒中患者静脉溶栓治疗分析  

Treatment analysis of intravenous thrombolysis in patients with mild ischemic stroke

作　　者：宋兆慧 童燕娜[1] 段洪连[1] 封靖[1] 孟繁花[1] 杜会山[1] 王佳伟[2] SONG Zhao⁃hui;TONG Yan⁃na;DUAN Hong⁃lian;FENG Jing;MENG Fan⁃hua;DU Hui⁃shan;WANG Jia⁃wei(Department of Neurology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京潞河医院神经内科,101149 [2]首都医科大学附属北京同仁医院神经内科,100730

出　　处：《中国现代神经疾病杂志》2019年第12期975-980,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号：81271311)~~

摘　　要：目的探讨重组组织型纤溶酶原激活物(rt⁃PA)治疗急性轻型缺血性卒中的有效性和安全性。方法纳入2017年11月至2018年10月发病4.50 h内入院的252例急性轻型缺血性卒中患者,分别行rt⁃PA静脉溶栓(静脉溶栓组,84例)、阿司匹林联合氯吡格雷双联抗血小板(双抗组,108例),以及阿司匹林或氯吡格雷抗血小板(单抗组,60例)治疗,治疗后24 h采用CT或MRI观察有无颅内出血,比较治疗前后血清超敏C⁃反应蛋白(hs⁃CRP)和红细胞沉降率(ESR)表达变化,并于入院后7 d、发病后21和90 d行改良Rankin量表评分判断预后。结果入院后7 d,不同治疗组患者血清hs⁃CRP(均P=0.000)和ESR(均P=0.000)水平降低,其中双抗组和单抗组血清hs⁃CRP(P=0.000,0.000)和ESR(P=0.000,0.010)高于静脉溶栓组;治疗后24 h,静脉溶栓组与抗血小板组颅内出血发生率差异无统计学意义[1.19%(1/84)对0(0/168);χ2=2.008,P=0.366]。入院后7 d,静脉溶栓组预后良好率高于双抗组(P=0.043)和单抗组(P=0.012);发病后21和90 d,静脉溶栓组预后良好率仅高于单抗组(P=0.021,0.037)。结论对于轻型缺血性卒中患者,尤其是症状轻微但可致残的患者应及时行rt⁃PA静脉溶栓,而因各种原因未能接受静脉溶栓治疗的患者则需在发病24小时内及时行阿司匹林联合氯吡格雷双联抗血小板治疗。Objective To analysis the safety and outcome of intravenous thrombolysis with recombinant tissue plasminogen activator(rt⁃PA)in patients with acute mild ischemic stroke.Methods From November 2017 to October 2018,252 patients with acute mild ischemic stroke who were admitted into our hospital within 4.50 h after onset(84 patients in intravenous thrombolysis group,108 patients in aspirin and clopidogrel group,and 60 patients in aspirin or clopidogrel group).The general condition,the level of high⁃sensitivity C⁃reactive protein(hs⁃CRP)and erythrocyte sedimentation(ESR)were compared among 3 groups.The modified Rankin Scale(mRS)were evaluated on 7 d after admission or at earlier discharge,and 21 and 90 d.Symptomatic intracranial hemorrhage rates were compared among 3 groups.Results There were no significant difference in general clinical data,the initial level of hs⁃CRP and ESR between the intravenous thrombolytic group and the 2 non⁃thrombolysis groups.At 7 d after admission or earlier discharge,the descending range of hs⁃CRP and ESR in 3 groups were significant(P=0.000,for all);there were significant differences among the 3 groups(P=0.000,for all);pairwise comparison of 3 groups showed that the levels of hs⁃CRP and ESR in intravenous thrombolytic group at 7 d were significantly lower than aspirin and/or clopidogrel group(P=0.000,0.000;P=0.000,0.010).There was no significant difference in the rate of intracranial hemorrhage between thrombolytic group and other 2 groups at 24 h after treatment[1.19%(1/84)vs.0(0/168);χ2=2.008,P=0.366].At 7 d after admission or earlier discharge, the intravenous thrombolytic group had better prognosis than aspirin and/or dopidogrel group (P =0.043, 0.012);At 21 and 90 d, the intravenous thrombolytic group had better prognosis than aspirin orclopidogrel group (P = 0.021, 0.037);but compared with aspirin and clopidogrel group, there was nosignificant difference (P = 0.070, 0.053). Conclusions Patients with mild ischemic stroke, especially thatmay induce disability should

关 键 词：卒中 脑缺血 组织型纤溶酶原激活物 

分 类 号：R74[医药卫生—神经病学与精神病学]