静脉溶栓治疗反复短暂性脑缺血发作的疗效分析  

Efficacy of intravenous thrombolysis for treatment of repeated transient ischemic attack

作　　者：吴雄枫 袁绘 沈红健[1] 邢鹏飞[1] 朱宣[1] 张敏敏[1] 林煌斌 张永巍[1] 吴涛[1] 邓本强[1] WU Xiong-feng;YUAN Hui;SHEN Hong-jian;XING Peng-fei;ZHU Xuan;ZHANG Min-min;LIN Huang-bin;ZHANG Yong-wei;WU Tao;DENG Ben-qiang(Neurovascular Center,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院脑血管病中心,上海200433

出　　处：《第二军医大学学报》2022年第1期55-59,共5页Academic Journal of Second Military Medical University

基　　金：上海申康医院发展中心临床研究关键支撑项目(SHDC2020CR6014)。

摘　　要：目的探讨静脉溶栓治疗以反复短暂性脑缺血发作(TIA)为临床表现的急性缺血性脑卒中患者的疗效和安全性。方法回顾性连续纳入2013年8月1日至2019年9月11日在我院脑血管病中心就诊、以反复TIA为临床表现的急性缺血性脑卒中住院患者共111例,根据是否接受静脉溶栓治疗将患者分为静脉溶栓组(57例)和对照组(54例,患者仅接受标准抗血小板药物治疗)。采用治疗后7 d美国国立卫生研究院卒中量表(NIHSS)评分评价早期疗效,其中治疗后NIHSS评分下降≥0分为有效。采用治疗后90 d改良Rankin量表(mRS)评分评价远期预后,其中mRS评分≤2分为预后良好。采用Heidelberg分类标准评估治疗后出血转化情况。结果两组患者的年龄、性别、高血压史、糖尿病史、ABCD2评分和治疗前TIA发作次数、NIHSS评分差异均无统计学意义(P均>0.05)。治疗后静脉溶栓组TIA再发次数低于对照组[0(0,2)次vs 0(0,18)次,P=0.028]。治疗后7 d,静脉溶栓组NIHSS评分下降≥0分的患者占比高于对照组[98.2%(56/57)vs 90.7%(49/54),P<0.001]。两组患者治疗后7 d磁共振弥散加权成像(DWI)阳性率、90 d预后良好率及无症状性颅内出血发生率差异均无统计学意义(P均>0.05)。两组患者均未发生症状性颅内出血及死亡。结论静脉溶栓可以改善以反复TIA为临床表现的急性缺血性脑卒中患者的早期神经功能,且远期疗效与标准药物治疗相仿。Objective To investigate the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke manifested as repeated transient ischemic attack(TIA).Methods A total of 111 acute ischemic stroke inpatients with repeated TIA who were admitted to Neurovascular Center of our hospital from Aug.1,2013 to Sep.11,2019were retrospectively included.The patients were divided into intravenous thrombolysis group(57 cases)and non-intravenous thrombolysis group(54 cases treated with standard antiplatelet drugs alone).National Institutes of Health stroke scale(NIHSS)score 7 d after treatment was used to evaluate the early efficacy(NIHSS score decreased by≥0 indicated effective).Modified Rankin scale(m RS)score 90 d after treatment was used to evaluated the long-term prognosis(m RS score≤2 indicated good prognosis).Heidelberg classification was used to evaluate the hemorrhagic transformation after treatment.Results There were no significant differences in age,gender,hypertension,diabetes mellitus,ABCD2(age,blood pressure,clinical features,duration of symptoms,diabetes mellitus)score,or TIA times and NIHSS score before treatment between the 2 groups(all P>0.05).After treatment,the recurrence times of TIA was significantly lower in the intravenous thrombolysis group than that in the non-intravenous thrombolysis group(0[0,2]vs 0[0,18],P=0.028).The proportion of patients whose NIHSS score decreased by≥07 d after treatment was significantly higher in the intravenous thrombolysis group than that in the nonintravenous thrombolysis group(98.2%[56/57]vs 90.7%[49/54],P<0.001).There were no significant differences in the positive rate of magnetic resonance diffusion weighted imaging(DWI)7 d after treatment,good prognosis rate 90 d after treatment or incidence of asymptomatic intracranial hemorrhage between the 2 groups(all P>0.05).No symptomatic intracranial hemorrhage or death occurred in the 2 groups.Conclusion Intravenous thrombolysis can improve the early neurological function of patients with acute ischemic s

关 键 词：反复短暂性脑缺血发作 缺血性脑卒中 静脉溶栓 预后 药物治疗 

分 类 号：R743.31[医药卫生—神经病学与精神病学]