重组组织型纤溶酶原激活剂(rt⁃PA)静脉溶栓时机对急性脑梗死患者的疗效和预后的影响  

Effect of Recombinant Tissue Fibrosis Agent(rt-PA)Venous Thrombosis Timing on The Efficacy and Prognosis of Patients with Acute Cerebral Infarction

作　　者：穆锋 宋薇 MU Feng;SONG Wei(Department of Neurology,Fengxiang County Hospital,Baoji,721400,China)

机构地区：[1]凤翔县医院神经内科,宝鸡721400

出　　处：《血栓与止血学》2022年第3期546-548,552,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓时机对急性脑梗死(ACI)患者的疗效和预后的影响。方法以80例ACI患者为对象,随机分为A组(n=27,溶栓时间3 h内)、B组(n=27,溶栓时间3~4.5 h)、C组(n=26,溶栓时间4.5~6 h)。以同期25例未接受溶栓治疗的ACI患者为对照组。对比四组疗效及预后。结果A组、B组、C组总有效率比较无差异(均P>0.05)。四组治疗后纤维蛋白原(Fbg)水平降低,抗凝血酶(AT)水平升高;A组、B组、C组治疗后Fbg水平低于对照组,AT水平高于对照组(P>0.05);A组、B组Fbg水平高于C组(P<0.05),三组AT水平比较无差异(P>0.05)。治疗后四组氧化低密度脂蛋白(ox-LDL)水平降低,谷胱甘肽过氧化物酶(GSH-px)水平升高(P<0.05);A组、B组、C组ox-LDL水平低于对照组,GSH-px水平高于对照组(P<0.05);A组、B组、C组间ox-LDL及GSH-px水平比较无差异(P>0.05)。三组症状性颅内出血、尿道出血、牙龈出血、过敏反应、血管再闭塞发生率比较无差异(P>0.05)。结论ACI后发病后4.5~6 h认为rt-PA静脉溶栓治疗的有效时间窗,可改善患者的凝血、血流变及氧化应激指标,安全性高。Objective To investigate the effect of the timing of recombinant tissue fibrosis agent(rt-PA)intravenous thrombolysis on the efficacy and prognosis of patients with acute cerebral infarction(ACI).Methods 80 patients with ACI were randomly divided into group A(n=27,thrombolysis time within 3 h),group B(n=27,thrombolysis time 3~4.5 h)and group C(n=26,thrombolysis time 4.5~6 h).25 ACI patients who did not receive thrombolytic therapy in the same period were used as the control group.The curative effect and prognosis of the four groups were compared.Results There was no difference in the total effective rate among group A,group B and group C(all P>0.05).After treatment,the level of fibrinogen(Fbg)decreased and the level of antithrombin(AT)increased in the four groups;After treatment,the level of Fbg in group A,group B and group C was lower than that in the control group,and the level of AT was higher than that in the control group(P>0.05);The level of Fbg in group A and group B was higher than that in group C(P<0.05),and there was no difference in the level of AT among the three groups(P>0.05).After treatment,the level of oxidized low density lipoprotein(ox LDL)decreased and the level of glutathione peroxidase(GSH PX)increased in the four groups(P<0.05);The level of ox LDL in group A,B and C was lower than that in the control group,and the level of GSH PX was higher than that in the control group(P<0.05);There was no difference in the levels of ox LDL and GSH PX among group A,group B and group C(P>0.05).There was no difference in the incidence of symptomatic intracranial hemorrhage,urethral hemorrhage,gingival hemorrhage,allergic reaction and vascular re occlusion among the three groups(P>0.05).Conclusion 4.5~6 hours after the onset of ACI,it is considered that the effective time window of rt-PA intravenous thrombolysis can improve the indexes of coagulation,hemorheology and oxidative stress,and has high safety.

关 键 词：静脉溶栓时机 急性脑梗死 疗效 预后 

分 类 号：R692[医药卫生—泌尿科学]