多模式CT指导下觉醒型缺血性卒中阿替普酶静脉溶栓的疗效及安全性研究  

Efficacy and safety of intravenous thrombolysis with alteplase for the treatment of wake-up ischemic stroke under the guidance of multimode CT

作　　者：杨江胜[1] 朱祖福[1] 沈丽萍[1] 吴淑芳[1] 方琪[2] YANG Jiang-sheng;ZHU Zu-fu;SHEN Li-ping;WU Shu-fang;FANG Qi(Department of Neurology,The Affiliated Jiangyin Hospital of Southeast University Medical College,Jiangyin Jiangsu 214400;Department of Neurology,The First Affiliated Hospital of Soochow University,Suzhou Jiangsu 215006,China)

机构地区：[1]东南大学医学院附属江阴医院神经内科,江苏江阴214400 [2]苏州大学附属第一医院神经内科,江苏苏州215006

出　　处：《蚌埠医学院学报》2023年第3期339-343,共5页Journal of Bengbu Medical College

基　　金：江阴市科技局(科技创新资金)社会发展科技示范项目(JYKJ3248)。

摘　　要：目的:研究多模式CT指导下觉醒型缺血性卒中(WUIS)病人阿替普酶静脉溶栓的疗效及安全性。方法:前瞻性纳入神经内科就诊,并在急诊多模式CT指导下给予阿替普酶静脉溶栓的WUIS病人28例(观察组);收集同时期发病时间窗<4.5 h的非WUIS采用阿替普酶静脉溶栓病人30例(对照组)。比较2组病人治疗前及治疗后24 h、7 d和14 d的凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]、血小板(PLT)、超敏C反应蛋白(hs-CRP)、美国国立卫生研究院卒中量表(NIHSS)评分、生活能力评分(Barthel)及临床疗效和结局。结果:观察组临床总有效率和临床结局良好率分别为78.57%和75.00%,对照组为83.33%和80.00%,2组差异均无统计学意义(P>0.05);观察组治疗后Fib、PLT和hs-CRP水平低于治疗前(P<0.05~P<0.01),PT和APTT水平高于治疗前(P<0.05~P<0.01);对照组变化趋势与观察组一致,但2组各时间点指标比较差异均无统计学意义(P>0.05);观察组治疗后NIHSS评分逐渐降低,Barthel指数逐渐增加,与治疗前比较差异有统计学意义(P<0.05);对照组变化趋势与观察组一致,但2组各时间点指标比较差异均无统计意义(P>0.05)。结论:应用急诊多模式CT可作为WUIS病人静脉溶栓的可靠影像学依据,且有效性和安全性较高。Objective:To study the efficacy and safety of intravenous thrombolysis with alteplase for the treatment of wake-up ischemic stroke(WUIS)under the guidance of multimode CT.Methods:A total of 28 patients with WUIS who were admitted to the neurology department and given intravenous thrombolysis with alteplase under the guidance of emergency multimode CT(observation group)were prospectively included.At the same time,30 patients(control group)who were not with WUIS at the same period with time window of contemporaneous onset<4.5 hours were collected.The coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)],platelet(PLT),high-sensitivity C-reactive protein(hs-CRP),National Institutes of Health stroke scale(NIHSS)score,living ability score(Barthel),clinical efficacy and outcome were compared between the two groups before treatment and 24,7 and 14 days after treatment.Results:The clinical total effective rate and clinical good outcome rate in the observation group were 78.57%and 75.00%,respectively,and those in the control group were 83.33%and 80.00%,there was no statistical significance between the two groups(P>0.05).After treatment,the levels of Fib,PLT and hs-CRP in the observation group were gradually lower than those before treatment,and the levels of PT and APTT were gradually higher than those before treatment,with statistical significance before and after treatment(P<0.05).The change trend of the control group was consistent with that of the observation group,but there was no statistical significance at each time point between the two groups(P>0.05).After treatment,the NIHSS score in the observation group decreased gradually and Barthel score increased gradually,which was statistically significant compared with that before treatment(P<0.05).The change trend of the control group was consistent with that of the observation group,but there was no statistical significance at each time point between the two groups(P>0.05).Conclusions:Emergency multimode CT can be used a

关 键 词：觉醒型缺血性卒中 多模式CT 阿替普酶 

分 类 号：R743.3[医药卫生—神经病学与精神病学]