重组组织型纤溶酶原激活剂静脉溶栓治疗颈内动脉系统急性脑梗死疗效安全性与分层研究.docVIP

重组组织型纤溶酶原激活剂静脉溶栓治疗颈内动脉系统急性脑梗死疗效安全性与分层研究 　　【摘要】 目的 探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗颈内动脉系统急性脑梗死的疗效及安全性,并评估不同TOAST分型急性脑梗死的疗效差异。方法 选择颈内动脉系统急性脑梗死患者51例,分为溶栓组33例(其中起病3 h内者25例,3~4.5 h者8例)和对照组18例,溶栓组予 rt-PA 0.9 mg/kg 静脉溶栓,对照组予常规治疗。观察比较两组患者治疗前、治疗后(2 h、24 h、7 d、90 d)的神经功能缺损程度(NIHSS)评分以及治疗前、治疗后(7 d、90 d)的Barthel指数(BI),并将3 h溶栓组按TOAST分型分亚组进行分层分析。结果 ①3 h溶栓组治疗后2 h、24 h、7 d的NIHSS评分与治疗后7 d、90 d的BI均较治疗前有统计学差异(P0.05);④3 h溶栓组出血事件的发生率高于对照组(P0.05)。亚组分析显示CE组的出血事件发生率高于LAA组和SAA组(P0.05)。结论 3 h内rt-PA 静脉溶栓治疗可显著改善神经功能缺损症状和预后,出血风险较对照组增加。小样本3~4.5 h溶栓病例也取得了较好的临床疗效。3 h溶栓组亚组分析显示LAA组疗效优于CE组,而SAA组疗效欠佳。CE组的出血风险高于LAA组和SAA组。 　　【关键词】 　　重组组织型纤溶酶原激活剂;静脉溶栓;急性脑梗死;颈内动脉系;TOAST分型 　　 　　Effective safety and subtypes snalysis of recombinant tissue plasminogen activator on the treatment of acute anterior circulation infarctionYANG Yong,XU Miao,PAN Xiao-ping,et al.Department of Neurology,Guangzhou First Municipal Hospital,Guangdong Province Guangzhou 510180,China 　　【Abstract】 Objective To study the efficacy and safety of recombinant tissue plasminogen activator(rt-PA)on the treatment of acute anterior circulation infarction and to analyze the difference of stroke subtypes on the base of TOAST classification.Methods There were 51 patients of acute anterior ciculation infarction who were divided into thrombolysis group(33 cases)and control group(18 cases).Among the thrombolysis group,25 cases were adminstered with rt-PA within 3 h onset of stroke and 8 cases were adminstered with rt-PA within 3 to 4.5 h in a dose of 0.9 mg/kg body weight.The control group was given the conventional therapy.A contrast of the NIHSS score,Barthel Index(BI)was made before treatment and on the different time after treatment.And the TOAST subtype analysis was done in the 3 h thrombolysis group.Results ①There was a significant difference between before and after the treatment in the 3 h thrombolysis group by all the NIHSS and BI(P0.05).④The incidence of hemorrhage in 3 h thrombolysis group was higher than that of the control group,while the