阿替普酶静脉溶栓治疗急性缺血性卒中临床分析  

Clinical analysis of intravenous rt-PA in patients with acute ischemic stroke with atrial fibrillation

作　　者：杨辉丽 翟明明[1] 彭静华[1] 闫俊强[1] 沈瑞乐[1] 张育德[1] YANG Huili;ZHAI Mingming;PENG Jinghua;YAN Junqiang;SHEN Ruile;ZHANG Yude(The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院,河南洛阳471000

出　　处：《中国实用神经疾病杂志》2020年第16期1429-1433,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省自然科学基金(编号:182300410333)。

摘　　要：目的探讨不同剂量重组组织型纤溶酶原激活剂(reconstructive tissue plasminogen activator,rt-PA,阿替普酶)静脉治疗合并房颤的急性缺血性卒中的安全性与疗效。方法选择2017-01-2019-11在河南科技大学第一附属医院神经内科接受rt-PA静脉溶栓治疗的70例合并心房颤动的急性缺血性脑卒中患者为实验组,选择同时期未给予rt-PA静脉溶栓治疗的38例合并心房颤动的急性缺血性脑卒中患者为对照组。将实验组患者随机分为低剂量组(0.6 mg/kg,A组)与标准剂量组(0.9 mg/kg,B组)。记录实验组溶栓前和溶栓后7 d NIHSS评分,记录对照组入院时和入院7 d NIHSS评分,记录3组患者7 d内的颅内出血发生情况和90 d病死率,采用改良Rankin量表(mRS)对各组患者90 d预后进行分析。结果低剂量组和标准剂量组患者溶栓后7 d较溶栓前NIHSS评分改善率均较对照组增高,差异有统计学意义(P<0.05)。rt-PA静脉治疗后,低剂量组颅内出血发生率和90 d病死率均低于标准剂量组,但组间比较无显著性差异(P>0.05);低剂量组与标准剂量组90 d预后良好率比较差异无统计学意义(P>0.05)。结论对于合并心房颤动的急性缺血性脑卒中患者,低剂量rt-PA与标准剂量rt-PA在功能恢复方面相比无显著性差异,但具有潜在较低的脑出血率及病死率。Objective To discuss the safety and effectiveness of intravenous rt-PA with different doses in patients with acute ischemic stroke with atrial fibrillation.Methods 70 patients with acute ischemic strokewith atrial fibrillation,admitted to and treated with rt-PA intravenous thrombolysis in our hospital from January 2017 to November 2019 were chosen in our study as the experimental group.The patients of experimental group were randomly divided into a low-dose group(0.6 mg/kg,group A)and a standard-dose group(0.9 mg/kg,group B).At the same period,38 patients with acute ischemic stroke complicated with atrial fibrillation who were not given rt-PA intravenous thrombolysis were selected as the control group.Recording the 7-day intracranial hemorrhage and 90-day mortality of each group patients.The modified Rankin Scale(mRS)was used to analyze the 90-day prognosis in each group patients.Results The improvement rate of the NIHSS score,7 days after thrombolysis compared with that before thrombolysis,in the low-dose group and the standard-dose group were higher than that in the control group,and the difference was statistically significant.After rt-PA intravenous treatment,the 7-day intracranial hemorrhage and 90-day mortality of the atrial fibrillation group patients in the low-dose group were lower than those in the standard-dose group,however,the differences were not obvious(P>0.05);the proportion of good prognosis at 90 days has no significant difference in the different dose groups(P>0.05).Conclusion For patients with acute ischemic stroke with atrial fibrillation,low-dose rt-PA is not inferior to standard dose of rt-PA in functional recovery,but the low-dose group has potentially lower rates of cerebral hemorrhage and mortality.

关 键 词：阿替普酶 心房颤动 急性缺血性脑卒中 静脉溶栓 

分 类 号：R743.33[医药卫生—神经病学与精神病学]