阿替普酶静脉溶栓前应用依达拉奉对老年急性脑梗死预后的影响  

Effects of edaravone on outcomes in the elderly patients with acute ischemic stroke treated with recombinant tissue plasminogen activator

作　　者：丁桂兵[1] 吴岩峰[1] 陈亮[1] 吴晋[1] 张鹏[1] DING Gui-bing;WU Yan-feng;CHEN Liang;WU Jin;ZHANG Peng(Department of Neurology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China)

机构地区：[1]南京医科大学第二附属医院神经内科,江苏省南京市210011

出　　处：《实用老年医学》2021年第3期301-305,共5页Practical Geriatrics

摘　　要：目的探讨老年急性脑梗死病人在应用阿替普酶(recombinant tissue plasminogen activator,rt-PA)静脉溶栓前预先使用依达拉奉的有效性和安全性。方法采用回顾性分析的方法,纳入2014~2018年南京医科大学第二附属医院脑卒中登记系统中接受rt-PA静脉溶栓及依达拉奉联合治疗的老年急性脑梗死病人,共135例。依据应用rt-PA静脉溶栓和依达拉奉的前后顺序,将病人分为依达拉奉前治疗组(67例)和依达拉奉后治疗组(对照组,68例)。分析2组病人在rt-PA静脉溶栓24 h、7 d后NIHSS评分,90 d改良Rankin量表(modified Rankin Scale,mRS)评分,溶栓后颅内出血和症状性颅内出血的发生率以及7 d、90 d死亡率等。应用Logistic回归分析方法探讨治疗后90 d预后的影响因素。结果2组24 h及7 d NIHSS评分差异有统计学意义[(8.67±8.55)分比(11.88±8.30)分;(5.08±5.35)分比(8.60±7.91)分]。2组90 d良好预后率差异有统计学意义(53.73%比27.94%)。溶栓后,依达拉奉前治疗组脑出血发生率(9.1%比18.3%,P<0.01)、症状性脑出血发生率(2.0%比8.7%,P<0.01)明显低于依达拉奉后治疗组,差异有统计学意义。2组7 d死亡率差异无统计学意义(4.0%比4.9%),依达拉奉前治疗组90 d死亡率明显低于依达拉奉后治疗组,差异有统计学意义(4.0%比12.5%,P=0.04)。Logistic回归分析显示,依达拉奉前治疗为预后良好的独立影响因素(OR=0.28,95%CI0.14~0.58)。结论在老年急性脑梗死病人中,rt-PA静脉溶栓前使用依达拉奉对90 d后神经功能改善效果优于溶栓后使用,同时可明显降低症状性脑出血发生率。Objective To investigate the effect edaravone before or after recombinant tissue plasminogen activator(rt-PA)on the outcome of acute ischemic stroke in the elderly patients.Methods A retrospective cohort study was conducted using the stroke register database in the Second Affiliated Hospital of Nanjing Medical University.A total of 135 elderly patients with ischemic stroke from 2014 to 2018 were selected.The patients received edaravone before rt-PA administration were enrolled as study group(n=67),and those who received edaravone after rt-PA were enrolled as control group(n=68).The scores of modified Rankin Scale(mRS)90 d after treatment,National Institutes of Health Stroke Scale(NIHSS)scores 24 h and 7 days after intravenous thrombolysis,the incidence rate of acute cerebral infarction hemorrhagic transformation,7-day and 90-day mortality were compared between the two groups.Results The NIHSS scores 24 h and 7 days after intravenous thrombolysis were lower in study group than those in control group(8.67±8.55 vs 11.88±8.30;5.08±5.35 vs 8.60±7.91),90 d recanalization rate was higher in study group than that in the control group(53.73%vs.27.94%).The rates of intracranial hemorrhage(ICH)(9.1%vs.18.3%)and the rate of symptomatic intracranial hemorrhage(sICH)(2.0%vs.8.7%)in study group were lower than those in control group.Logistic regression analysis showed that the administration of edaravone before rt-PA was significantly associated with lower mRS scores of the patients(OR=0.28,95%CI 0.14-0.58).Conclusions The administration of edaravone before rt-PA may improve the outcome in the elderly patients with acute ischemic stroke treated with rt-PA.

关 键 词：急性脑梗死 老年人 依达拉奉 阿替普酶 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]