rtPA静脉溶栓治疗急性脑梗死临床研究.docVIP

rtPA静脉溶栓治疗急性脑梗死临床研究 　　【摘要】 目的 评价重组组织型纤溶酶原激活剂(rtPA)静脉溶栓治疗急性脑梗死前后的血浆纤维蛋白原(FG)水平及疗效。方法 选择发病6 h内的急性脑梗死患者38例,随机分为溶栓组和对照组(各19例)。溶栓组采用rtPA(0.8 mg/kg)静脉溶栓,对照组采用常规的活血化瘀营养脑细胞控制并发症治疗。进行两组患者治疗前,治疗后1 d、3 d、5 d、7 d的血浆FG测定,治疗前,治疗后2 h、7 d、14 d、21 d、90 d欧洲卒中神经功能缺损程度评分(ESS),以及治疗前,治疗后,7 d、14 d、21 d、90 d的Barthel指数评分比较。结果 随访90 d,溶栓组血浆FG水平下降明显,ESS 评分和Barthel指数显著高于对照组,两组比较差异有显著性意义。结论 rtPA静脉溶栓治疗可使急性脑梗死患者血浆FG水平明显下降,神经功能缺损早期恢复,改善90 d的预后。 　　【关键词】 　　重组组织型纤溶酶原激活剂;血浆纤维蛋白原;急性脑梗死;静脉溶栓治疗 　　 　　Clinical effects of rtPA thrombolytic therapy for acute cerebral infarction 　　 　　CHEN Hui,CHEN Qiuhong,XU Jianhua.Department of Neurology,Shanghai Jiading District Central Hospital,Shanghai 201800,China 　　 　　【Abstract】 Objective To evaluate the efficacy and level of plasma fibrinogen after treatment of recombinant tissue plasminogen activator(rtPA)for patients with acute cerebral infarction.Methods 38 patients consistent with the inclusion criteria(6 h)were randomly divided into thrombolysis group and control group in average.rtPA was administered in a dose of 0.8 mg/kgin thrombolysis group.The control group received only routine treatment including chinses tradictional mendice and controlling complication ect.Level of plasma fibrinogen,European Stroke Scale(ESS)and Barthel Index(BI)were used to evaluate the recovery ofneurological functions.Results Level of plasma fibrinogen decreased obviously in thrombolysis groups and European Stroke Scaleand Barthel Index was significantly higher than that in the control group(all P0.05).Conclusion Level of plasma fibrinogen decrease obviously in patients with acute cerebral infarction after thrombolytic therapy of rtPA,neurologic impairment recover early and improve prognosis. 　　【Key words】 　　rtPA; Thrombolytic therapy; Acute cerebral infarction;Fibrinogen 　　 　　DOI:10.3760/cma.j.issn2010.01.39 　　作者单位:201800上海市嘉定区中心医院神经内科 　　 　　脑梗死患者血浆FG浓度明显增高,在溶栓治疗中监测血浆FG浓度成为一项重要的临床生物学指标,特别是近年来证实,FG水平升高与动脉硬化血栓合并症的发生和发密切相关?[1]?。超早期有效的溶栓是目前公认的治疗脑梗死的首选方法?[2]?,只有尽早溶解血栓,再通闭塞的脑血管,及时恢