低剂量rt-PA在桥接治疗AIS合并房颤中临床安全性和有效性分析  

作　　者：黄良通 徐灵燕 彭潇[1] 蔡学礼[1] 

机构地区：[1]浙江省丽水市中心医院(浙江大学附属丽水医院),323000

出　　处：《浙江临床医学》2021年第2期223-224,227,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省丽水市公益性技术应用项目(2019GYX23)。

摘　　要：目的探讨低剂量重组组织型纤溶酶原激活剂(rt-PA)对急性缺血性脑卒中(AIS)合并心房颤动患者急诊血管内介入治疗桥接前静脉溶栓的临床可行性和安全性。方法收集2016年6月至2019年5月急诊收治的发病4.5 h内合并房颤的AIS患者62例,所有患者均进行rt-PA静脉溶栓后桥接血管内介入治疗,按rt-PA使用剂量随机分为标准剂量组(0.9 mg/kg)和低剂量组(0.6 mg/kg),观察两组患者血管再通、神经功能恢复、安全性。结果共纳入62例患者,其中标准剂量组34例,低剂量组28例。两组患者血管再通率、溶栓后24 h NIHSS评分、7 d NIHSS评分、90 d MRS评分良好差异均无统计学意义(F>0.05)。低剂量组治疗后脑出血发生率低于标准剂量组(P<0.05)。低剂量组治疗后症状性脑出血发生率低于标准剂量组,但两组间比较差异无统计学意义(P>0.05).3个月随访两组分别有6例和4例死亡,两组间比较差异无统计学意义(P>0.05).结论对合并房颤的AIS患者静脉溶栓桥接血管内介入治疗,相比标准剂量,使用低剂量治疗有效性相似,脑出血风险较低。Objective To investigate the clinical feasibility and safety of low—dose recombinant tissue—type plasminogen activator ( rt—PA ) inemergency endovascular interventional therapy for pre—bridging intravenous thrombolysis in patients with acute ischemic stroke complicated with atrialfibrillation. Methods 62 patients with AIS compEcated with atrial fibrillation were collected from June 2016 to May 2019 in Lishui Central Hospital ofZhejiang Province. All patients were treated with rt—PA intravenous thrombolysis and bridged intravascular interventional therapy. According to the dosageof rt—PA, the patients were randomly divided into standard dose group ( 0.9 mg/kg body weight ) and low dose group ( 0.6 mg/kg body weight ).The vascular recanalization, neurological function recovery and safety of the two groups were observed. Results A total of 62 patients were included,including standard dose group ( n=34 ) and low dose group ( n=28 ) . There was no significant difference in vascular recanalization, NIHSS score at 24hours, NIHSS score at 7 days and MRS score at 90 days after thrombolysis between the two groups ( P>0.05 ) . The incidence of cerebral hemorrhage inthe low dose group was lower than that in the standard dose group ( P<0.05 ) . The incidence of symptomatic cerebral hemorrhage in the low dose group waslower than that in the standard dose group, but there was no significant difference between the two groups ( P>0.05 ) . During the 3 month follow up, 6cases and 4 cases died in the two groups respectively, and there was no significant difference between the two groups ( P>0.05 ) . Conclusion Comparedwith the standard dose, the efficacy of low dose therapy is similar and the risk of cerebral hemorrhage is lower in AIS patients with atrial fibriUation byintravenous thrombolysis and perform bridging therapy.

关 键 词：重组组织型纤溶酶原激活剂 脑梗死 静脉溶栓 机械取栓 

分 类 号：R74[医药卫生—神经病学与精神病学]