小剂量阿替普酶治疗急性脑梗死患者的临床疗效及安全性评价  

Clinical Efficacy and Safety of Low Dose Alteplase in the Treatment of Patients with Acute Cerebral Infarction

作　　者：纪芳 李彬 王晓娟[1] 杨莎莎 朱蕾 舒冰 薛敏[2] JI Fang;LI Bin;WANG Xiao-juan;YANG Sha-sha;ZHU Lei;SHU Bing;XUE Min(Department of Pharmaceutical,The First Affiliated Hospital of Anhui University of TechnologyHuainan First People's Hlospital,Huainan,Anhui,232007,China;Department of lnternal Neurology,The First Affiliated Hospital of Anhui University of Technology/Huainan First People's Hospital,Huainan,Anhui,232007,China;Department of Pharmacy,The First Alfiliated Hospital of University of Science and'Technology of China/Anhui Provincial Hospital,Hefei,Anhui,230001,China)

机构地区：[1]安徽理工大学第一附属医院/淮南市第一人民医院药学部,安徽淮南232007 [2]安徽理工大学第一附属医院/淮南市第一人民医院神经内科,安徽淮南232007 [3]中国科学技术大学附属第一医院/安徽省立医院药剂科,安徽合肥230001

出　　处：《现代生物医学进展》2020年第18期3592-3595,3600,共5页Progress in Modern Biomedicine

基　　金：安徽高校自然科学研究重点项目(KJ2019A0096);淮南市科技计划项目(2018A379);蚌埠医学院自然科学类项目(BYKY2019315ZD)。

摘　　要：目的:探讨急性脑梗死患者静脉溶栓使用小剂量(0.6 mg/kg)阿替普酶的临床疗效及安全性。方法:将2016年1月至2019年12月我院神经内科收治的溶栓时间窗内40例急性脑梗死患者随机分为标准剂量组(0.9 mg/kg)和小剂量组(0.6 mg/kg),每组20例,分别在溶栓前、溶栓后1小时对患者进行美国国立卫生研究院卒中量表(NIHSS)评分,溶栓前和溶栓后24小时做头颅CT排除脑出血,密切监测不良反应。结果:标准剂量组有效率为80.00%,小剂量组有效率为75.00%,两组比较差异无统计学意义(P>0.05)。治疗前两组NIHSS评分比较差异无统计学意义(P>0.05),治疗后两组NIHSS评分均降低,与治疗前相比差异有统计学意义(P<0.05),治疗后两组NIHSS评分差异无统计学意义(P>0.05)。标准剂量组总不良反应发生率为40.00%,高于小剂量组的20.00%,差异无统计学意义(P>0.05)。结论:阿替普酶可有效改善急性脑梗死患者的神经功能,小剂量(0.6 mg/kg)与标准剂量(0.9 mg/kg)溶栓效果相当,安全性较好,出血事件发生率较低,可根据患者情况酌情选用小剂量。Objective:To investigate the clinical efficacy and safety of low-dose(0.6 mg/kg)alteplase in patients with acute cerebral infarction.Methods:40 acute cerebral infarctionpatients within thrombolysis time window admitted in neurology department of our hospital from January 2016 to December 2019 were randomly divided into standard dose group(0.9 mg/kg)and small dose group(0.6 mg/kg),there were 20 cases in each group.National Institutes of Health Stroke Scale(NIHSS)scores were assessed before and 1 hour after thrombolysis.CT scan was performed before and 24 hours after thrombolysis to exclude cerebral hemorrhage and close monitor of adverse reactions.Results:The effective rate was 80.00%in standard dose group and 75.00%in small dose group,there was no significant difference between the two groups(P>0.05).There was no significant difference in NIHSS scores between the two groups before treatment(P>0.05).NIHSS scores in both groups were decreased after treatment,the difference was statistically significant compared with before treatment(P<0.05).There was no significant difference in NIHSS score between the two groups after treatment(P>0.05).The total incidence of adverse reactions was 40.00%in the standard dose group,which was higher than 20.00%in the small dose group,the difference was no statistically significant(P>0.05).Conclusion:Alteplase can effectively improve the neurological function of patients with acute cerebral infarction.The thrombolytic effect of low dose(0.6 mg/kg)is similar to that of standard dose(0.9 mg/kg),the safety is good and the incidence of bleeding is low.Small dose can be selected according to the patient’s condition.

关 键 词：阿替普酶 静脉溶栓 急性脑梗死 不良反应 剂量 神经功能 

分 类 号：R743[医药卫生—神经病学与精神病学]