不同时间窗静脉溶栓对急性缺血性脑卒中患者临床疗效、血管再通和神经功能的影响  

Effects of Intravenous Thrombolysis at Different Time Windows on Clinical Efficacy,Vascular Recanalization and Neurological Function in Patients with Acute Ischemic Stroke

作　　者：曲广枝 蒋波[2] 孙秀丽[2] 于建 QU Guang-zhi;JIANG Bo;SUN Xiu-li;YU Jian(Department of Health Management Section,Dalian Friendship Hospital,Dalian,Liaoning 160011,China;Department of Nursing,,Dalian Friendship Hospital,Dalian,Liaoning 160011,China;the Second Department of Neurology,Dalian Friendship Hospital,Dalian,Liaoning 160011,China)

机构地区：[1]大连市友谊医院健康管理科,辽宁大连160011 [2]大连市友谊医院护理部,辽宁大连160011 [3]大连市友谊医院神经二科,辽宁大连160011

出　　处：《解放军医药杂志》2021年第3期91-94,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：辽宁省自然科学基金指导计划项目(201802258)。

摘　　要：目的分析不同时间窗静脉溶栓对急性缺血性脑卒中患者临床疗效、血管再通和神经功能的影响。方法选取2017年3月—2019年3月本院收治的急性缺血性脑卒中患者120例,按照静脉溶栓时间窗分为A组和B组各60例。A组静脉溶栓时间控制在4.5 h内,B组静脉溶栓时间控制在4.5~12.0 h。比较2组临床疗效和治疗后血管狭窄、血管再通及继发出血情况,以及治疗前后神经功能缺损程度[美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)]、日常生活能力(改良Rankin量表)、生活质量[Barthel指数(Barthel index,BI)量表]。结果治疗后A组临床总有效率显著高于B组(P<0.05);治疗后2组NIHSS评分均得到改善,而治疗1周后及治疗3个月后A组NIHSS评分均低于B组,差异有统计学意义(P<0.05或P<0.01);治疗后2组改良Rankin量表评分均降低,BI评分均升高,且A组改良Rankin量表评分降低及BI评分升高程度均大于B组,差异有统计学意义(P<0.05或P<0.01);2组血管狭窄、血管再通及继发出血率比较差异无统计学意义(P>0.05)。结论急性缺血性脑卒中患者需早期开展静脉溶栓治疗,时间窗控制在4.5 h内可提高临床疗效、促进患者神经功能恢复,且预后佳。Objective To analyze the clinical effect of intravenous thrombolysis at different time windows on clinical efficacy,vascular recanalization and neurological function in patients with acute ischemic stroke(AIS).Methods A total of 120 patients with AIS admitted to our hospital from March 2017 to March 2019 were selected and divided into group A and group B according to the intravenous thrombolytic time window,with 60 cases in each group.The intravenous thrombolytic time was controlled within 4.5 h in group A and 4.5-12.0 h in group B.The clinical efficacy,vascular stenosis,recanalization and secondary bleeding after treatment,as well as neurological deficit[national institutes of health stroke scale(NIHSS)],activities of daily living(modified Rankin scale)and quality of life[Barthel index(BI)scale]were compared between the two groups.Results After treatment,the total effective rate of group A was significantly higher than that of group B(P<0.05);NIHSS scores of both groups were improved after treatment,while NIHSS scores of group A were lower than those of group B at 1 week and 3 months after treatment(P<0.05 or P<0.01).After treatment,the modified Rankin scale scores of both groups were decreased,while BI scores were increased,and the decrease in the Rankin scale scores and the increase in BI score was greater in group A than in group B(P<0.05 or P<0.01).There was no significant difference in the rate of vascular stenosis,recanalization and secondary bleeding between the two groups(P>0.05).Conclusion Patients with AIS need early intravenous thrombolytic therapy,and the time window control within 4.5 h can help improve the clinical efficacy,and promote the recovery of neurological function,and the prognosis is good.

关 键 词：卒中 脑缺血 静脉溶栓 时间窗 NIHSS评分 血管狭窄 血管再通 

分 类 号：R743[医药卫生—神经病学与精神病学]