阿替普酶静脉溶栓治疗急性缺血性脑卒中的临床研究  

Clinical study of the intravenous thrombolysis effect of alteplase on acute ischemic stroke

作　　者：孟伟建[1] 卢蕾[1] 张宏博 秦会敏[1] 高倩[1] 崔永健[1] 魏琰[1] MENG Weijian;LU Lei;ZHANG Hongbo;QIN Huimin;GAO Qian;CUI Yongjian;WEI Yan(Harrison International Peace Hospital(Hengshui City People′s Hospital),Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院(衡水市人民医院),衡水053000

出　　处：《西北药学杂志》2021年第2期279-282,共4页Northwest Pharmaceutical Journal

基　　金：衡水市科技计划项目(编号:2016014084Z)。

摘　　要：目的探索阿替普酶治疗急性缺血性脑卒中的疗效和影响急性缺血性脑卒中静脉溶栓预后的因素,积极干预相关因素,提高静脉溶栓治疗的效率。方法随机抽取急性缺血性脑卒中患者120例,入组患者注射阿替普酶行静脉溶栓治疗,在静脉溶栓后24 h和3个月,分别采用美国国立卫生研究院卒中量表(NIHSS)评分和改良神经功能量表(mRS)评分评价神经功能的改善程度和预后,应用Logistic回归分析影响急性缺血性脑卒中患者溶栓治疗预后的危险因素。结果静脉溶栓后24 h预后良好的有84例(70.0%),恢复不良的有36例(30.0%);静脉溶栓后24 h NIHSS评分为(11.23±0.68)分,较溶栓前的(16.11±1.32)分明显降低(P<0.05)。静脉溶栓后3个月预后良好有70例(58.3%),预后不良为50例(41.7%);静脉溶栓后3个月mRS评分为(2.10±0.18)分,较溶栓前的(3.14±0.41)分明显降低(P<0.05)。Logistic回归分析显示,脂蛋白A1/B比值、发病至入院时间(OTD)、入院至溶栓时间(DTN)、NIHSS评分、高尿酸水平和高同型半胱氨酸(Hcy)的OR值分别为1.012、1.679、1.435、1.457、0.305、1.201,P值分别为0.011、0.007、0.032、0.004、0.005、0.015。结论阿替普酶治疗急性缺血性脑卒中疗效显著,脂蛋白A1/B比值、OTD、DTN、NIHSS评分、高尿酸水平和Hcy血症是影响预后的危险因素。Objective To explore the efficacy of alteplase in the treatment of acute ischemic stroke and the influential factors of prognosis of intravenous thrombolysis in the early stage of acute ischemic stroke,and actively intervene related factors to improve the effectiveness of thrombolytic therapy.Methods A total of 120 cases of acute ischemic stroke were randomly selected,and the patient was injected with alteplase for intravenous thrombolytic therapy at 24 h and 3 months after thrombolysis.The National Institutes of Health Stroke Scale(NIHSS)stroke scale was used for evalution.And modified RANKIN scale(mRS)were used to evaluate the degree of neurological improvement and prognosis.Logistic regression analysis was used to analyze the risk factors that affect the prognosis of thrombolytic therapy in patients with acute ischemic stroke.Results According to the NIHSS scale,84 patients(70.0%)had a good prognosis at 24 h after thrombolysis,and 36 patients(30.0%)had poor recovery.The NIHSS score(11.23±0.68)at 24 h after thrombolysis was lower than that before(16.11±1.32),(P<0.05).3 months after thrombolysis,the prognosis was good in 70 cases(58.3%),and the prognosis was poor in 50 cases(41.7%).The mRS score(2.10±0.18)at 3 months after thrombolysis was lower than before(3.14±0.41)(P<0.05).Logistic regression analysis showed the OR values of lipoprotein A1/B ratio,time from onset to admission(OTD);admission to thrombolysis time(DTN),NIHSS score,high uric acid level and high homocysteine(Hcy)were 1.012,1.679,1.435,1.457,0.305 and 1.201,P values were 0.011,0.007,0.032,0.004,0.005 and 0.015,respectively.Conclusion Alteplase is significantly effective in the treatment of acute ischemic stroke.The ratio of lipoprotein A1/B,OTD,DTN,NIHSS score,high uric acid level and hyperhomocysteinemia are risk factors affecting prognosis.

关 键 词：阿替普酶 重组组织型纤溶酶原激活物(tPA) 急性缺血性脑卒中 脂蛋白A1/B比值 

分 类 号：R972[医药卫生—药品]