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目的探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗急性脑梗死的临床疗效。方法 69例发病在4.5小时内具有溶栓指征的急性脑梗死患者,其中观察组37例行rt-PA静脉溶栓,对照组32例行常规抗血小板治疗。以美国国立卫生院卒中量表(NIHSS)评分评定溶栓后临床疗效,以Barthel指数(BI)评分及改良Rankin量表(mRS)评分判断治疗后90d生活质量及预后。结果观察组治疗后2h、24h、7d NIHSS评分显著低于对照组[(9.23±3.51)vs(11.32±1.12),(6.72±2.31)vs(9.24±2.53),(4.23±2.12)vs(7.34±1.43)],差异有统计学意义(P<0.05);治疗后90天BI评分观察组显著高于对照组[(78.56±3.51)vs(61.30±4.13)],差异有统计学意义(P<0.05);治疗后90天mRS评分疗效良好率观察组显著高于对照组[67.56%(25/37)vs 34.38%(11/32)],差异有统计学意义(P<0.01)。观察组24h脑出血率及死亡率高于对照组[16.21%(6/37)vs 9.37%(3/32)],但差异无统计学意义(P>0.05)。结论时间窗内rt-PA静脉溶栓治疗急性脑梗死近、远期疗效均较常规抗血小板治疗显著。
Objective To investigate the clinical effect of intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction. Methods Sixty-nine patients with acute cerebral infarction who had an indication of thrombolysis within 4.5 hours, 37 in the observation group underwent intravenous thrombolysis with rt-PA and 32 in the control group received conventional antiplatelet therapy. The NIHSS score was used to assess the clinical efficacy after thrombolysis. The Barthel Index (BI) and Modified Rankin Scale (mRS) were used to evaluate the quality of life and prognosis at 90 days after treatment. Results The scores of NIHSS in observation group were significantly lower than those in control group [(9.23 ± 3.51) vs (11.32 ± 1.12), (6.72 ± 2.31) vs (9.24 ± 2.53), (4.23 ± 2.12 vs ± 1.43)], the difference was statistically significant (P <0.05); the BI score in observation group at 90 days after treatment was significantly higher than that in control group [(78.56 ± 3.51) vs (61.30 ± 4.13)], P <0.05 <0.05). The effective rate of mRS score 90 days after treatment was significantly higher in the observation group than that in the control group [67.56% (25/37) vs 34.38% (11/32)], the difference was statistically significant (P <0.01). The rate of cerebral hemorrhage and mortality in observation group were higher than those in control group [16.21% (6/37) vs 9.37% (3/32)], but the difference was not statistically significant (P> 0.05). Conclusion rt-PA intravenous thrombolysis in the treatment of acute cerebral infarction in the short-term, long-term efficacy than conventional antiplatelet treatment was significant.