低剂量rt-PA静脉溶栓联合双重抗血小板聚集治疗频发高危短暂性脑缺血发作效果及近期预后、安全性分析  

Clinical Efficacy of Intravenous Thrombolysis with Low-dose rt-PA Combined with Dual Antiplatelet Aggregation in Treatment of Patients with Frequent High-risk Transient Ischemic Attacks and Its Short-term Prognosis and Safety

作　　者：王立敏 吴慧君[1] 王建平 王宁宁 曲明卫[1] 杨潮萍[1] WANG Li-min;WU Hui-jun;WANG Jian-ping;WANG Ning-ning;QU Ming-wei;YANG Chao-ping(Department of Neurology,the Central Hospital of Cangzhou City,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市中心医院神经内科,河北沧州061000

出　　处：《解放军医药杂志》2022年第5期69-71,共3页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：2018年沧州市科学计划自筹经费项目(183302073)。

摘　　要：目的探讨低剂量阿替普酶(rt-PA)静脉溶栓联合双重抗血小板聚集治疗频发高危短暂性脑缺血发作(TIA)的效果、近期预后及安全性。方法选取2015年1月—2019年3月我院频发高危TIA 132例,据治疗方法的不同分为A组[低剂量rt-PA(0.6 mg/kg)静脉溶栓联合双重抗血小板聚集治疗]63例和B组[标准剂量rt-PA(0.9 mg/kg)静脉溶栓联合双重抗血小板聚集治疗]69例。比较2组疗效,治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及凝血指标变化,2组近期预后及治疗安全性。结果2组总有效率、复发率、病死率比较差异无统计学意义(P>0.05)。随着治疗时间的延长2组活化部分凝血活酶时间、凝血酶原时间较治疗前逐渐升高,NIHSS评分、纤维蛋白原、D-二聚体较治疗前逐渐下降(P<0.05)。A组不良反应总发生率低于B组(P<0.05)。结论低剂量(0.6 mg/kg)rt-PA静脉溶栓联合双重抗血小板聚集治疗在改善频发高危TIA患者神经功能、凝血指标、近期预后方面较为理想,且安全性高。Objective To investigate clinical efficacy,short-term prognosis and safety of intravenous thrombolysis with low-dose Alteplase(rt-PA)combined with dual antiplatelet aggregation in treatment of patients with frequent and high-risk transient ischemic attacks(TIA).Methods A total of 132 patients with frequent high-risk TIA between January 2015 and March 2019 were selected and divided into group A[intravenous thrombolysis with low-dose rt-PA(0.6 mg/kg)combined with dual antiplatelet aggregation therapy,n=63]and group B[intravenous thrombolysis with standard dose rt-PA(0.9 mg/kg)combined with dual antiplatelet aggregation therapy,n=69]according to different therapeutic methods.Clinical efficacy,changes of National Institutes of Health Stroke Scale(NIHSS)score and coagulation indexes before and after treatment,as well as the short-term prognosis and therapeutic safety were compared between two groups.Results There were no significant differences in the total effective rate,recurrence rate and mortality between two groups(P>0.05).With prolonging therapeutic time,activated partial thromboplastin time(APTT)and prothrombin time(PT)were increased gradually,while NIHSS score,levels of fibrinogen(FIB)and D-dimer(DD)were decreased gradually compared with those before treatment in two groups(P<0.05).The total incidence rate of adverse reactions in group A was significantly lower than that in group B(P<0.05).Conclusion Intravenous thrombolysis with low-dose(0.6 mg/kg)rt-PA combined with dual antiplatelet aggregation is ideal in improving neurological function,coagulation indexes and short-term prognosis with good safety in treatment of patients with frequent and high-risk TIA.

关 键 词：脑缺血发作 短暂性 组织型纤溶酶原激活物 静脉溶栓 血小板聚集抑制剂 近期预后 

分 类 号：R743.31[医药卫生—神经病学与精神病学]