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目的:探讨重组组织型纤溶酶原激活剂(rt-PA)超早期静脉溶栓治疗急性脑梗死(ACI)的疗效。方法:对60例发病<3 h的ACI患者随机分为rt-PA组和对照组,每组各30例。rt-PA组给予rt-PA总量0.9 mg.kg-1,最大剂量50 mg进行静脉溶栓治疗。对照组应用达肝素钠5 000 IU皮下注射,bid,共7 d。治疗前及治疗后2 h,24 h,14 d及3个月时分别采用美国国立卫生院卒中量表(NIHSS)评分,以及溶栓后3个月日常生活能力Barthal指数(BI)评分,继发性颅内出血(sICH)率及3个月时的死亡率评价其疗效及安全性。结果:rt-PA组较对照组在各时间点(2 h,24 h,14 d,3个月)的NIHSS评分均有改善(P<0.05);rt-PA组较对照组在3个月后的BI指数评分有显著改善(P<0.01)。而两组在sICH率及3个月时的死亡率无明显差异(P>0.05)。结论:ACI发病3 h内给予rt-PA静脉溶栓治疗安全,有效。
Objective: To investigate the effect of ultra-early intravenous thrombolysis on acute cerebral infarction (ACI) by recombinant tissue plasminogen activator (rt-PA). Methods: Sixty ACI patients with onset <3 h were randomly divided into rt-PA group and control group, with 30 patients in each group. rt-PA group was given rt-PA total 0.9 mg.kg-1, the maximum dose of 50 mg intravenous thrombolytic therapy. Control group dalteparin 5000 IU subcutaneous injection, bid, a total of 7 d. The National Institutes of Health Stroke Scale (NIHSS) score and the Barthal Index (BI) scores of daily living ability at 3 months after thrombolysis were used before treatment and 2 h, 24 h, 14 d and 3 months after treatment respectively The efficacy and safety of intracranial hemorrhage (sICH) and mortality at 3 months were evaluated. Results: The NIHSS scores of rt-PA group were significantly improved at all time points (2 h, 24 h, 14 d, 3 months) (P <0.05) After the BI index score was significantly improved (P <0.01). There was no significant difference in sICH rate and 3-month mortality between the two groups (P> 0.05). Conclusion: Intravenous thrombolysis with rt-PA within 3 h after ACI is safe and effective.