rt-PA和尿激酶静脉溶栓治疗急性脑梗死安全性比较及对血栓弹力图的影响  

Comparison of safety of intravenous thrombolytic therapy with rt-PA and urokinase in acute cerebral infarction and its effect on thromboelastogram

作　　者：杨丽亚[1] 张业敏[1] 葛伟[1] 刘松岩[2] 祝善尧[1] YANG Liya;ZHANG Yemin;GE Wei(Department of Neurology,Chaohu Hospital of Anhui Medical University,Chaohu 238000,China)

机构地区：[1]安徽医科大学附属巢湖医院神经内科,安徽合肥238000 [2]吉林大学中日联谊医院神经内科,吉林长春130033

出　　处：《中风与神经疾病杂志》2022年第1期43-45,共3页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技发展计划项目(20180311075YY)。

摘　　要：目的比较rt-PA和UK在我国常规临床实践中对发病6 h内缺血性卒中(AIS)的疗效和安全性。比较rt-PA与UK这两种溶栓剂对血栓弹力图(TEG)各参数的影响,TEG各参数与rt-PA、UK静脉溶栓安全性的关系。方法收集安徽医科大学附属巢湖医院2018年7月至2021年2月期间、接受rt-PA(4.5 h内)或UK(6 h内)静脉溶栓治疗的AIS患者102例,其中59例接受rt-PA治疗,43例接受UK治疗,记录入院时、溶栓前患者的NIHSS评分,溶栓后14 d(或出院时)患者的NIHSS评分,记录颅内出血及消化道出血并发症,两组患者住院期间死亡人数等指标。同时记录静脉溶栓后TEG各参数(包括R、MA、K、αangle、CI),对rt-PA组与UK组患者的R、MA、K、αangle、CI各指标进行对比分析。结果rt-PA组和UK组住院期间神经功能好转情况、死亡率、颅内出血及消化道出血发生率情况的比较,无统计学上差异(P>0.05);rt-PA组和UK组患者MA值的比较,有统计学差异。发生出血并发症的患者(出血组)R值均值大于非出血组,具有统计学上差异。结论rt-PA和UK对AIS患者的疗效、安全性相似。rt-PA和UK均可改善AIS患者的预后。UK组静脉溶栓后低凝状态较rt-PA组可能更显著,出血组较非出血组R时间延长,对急性脑梗死静脉溶栓后出血有一定的预测作用。Objective To compare the efficacy and safety of rt-PA and UK in the treatment of ischemic stroke(AIS)within 6 hours of onset in routine clinical practice in China.To compare the effects of rt-PA and UK on various parameters of thrombelastogram(TEG),and the relationship between various parameters of thrombelastogram and the safety of intravenous thrombolytic therapy of rt-PA and UK were compared.Methods A total of 102 AIS patients who received intravenous thrombolytic therapy of rt-PA(within 4.5 h)or UK(within 6 h)in chaohu hospital affiliated to anhui medical university from July 2018 to February 2021 were collected.including 59 patients who received rt-PA and 43 patients who received urokinase.NIHSS scores of patients on admission and before thrombolytic therapy,NIHSS scores of patients 14 days after thrombolytic therapy(or at discharge),complications of intracranial hemorrhage and digestive tract hemorrhage,and the number of deaths during hospitalization of patients in the two groups were recorded.At the same time,TEG parameters(including R,MA,K,αAngle and CI)after intravenous thrombolysis were recorded,and the indicators of R,MA,K,αAngle and CI of rt-PA group and UK group were compared and analyzed.Results There were no significant differences in neurological improvement,mortality,incidence of intracranial hemorrhage and digestive tract hemorrhage between rt-PA group and UK group(P>0.05).There were statistically significant differences in MA value between rt-PA group and urokinase group.The mean R value of patients with bleeding complications(bleeding group)was higher than that of non-bleeding group,and the difference was statistically significant.Conclusions Rt-PA and UK have similar efficacy and safety in AIS patients.Both rt-PA and UK can improve the prognosis of AIS patients.After intravenous thrombolysis,the hypocoagulant state of the UK group may be more significant than that of the rt-PA group,and the R time of the bleeding group is longer than that of the non-bleeding group,which has a certain predic

关 键 词：静脉溶栓 RT-PA 急性脑梗死 尿激酶 血栓弹力图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]