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目的评估重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后循环脑梗死的有效性和安全性。方法采用回顾性分析方法,选取我院2010年1月—2014年12月发病6h内的后循环脑梗死患者53例,其中接受rt-PA溶栓治疗的27例患者为溶栓组,不接受溶栓、仅接受常规抗血小板聚集或抗凝治疗的26例患者为非溶栓组。收集研究对象年龄、性别、危险因素、既往史、用药史、影像学及实验室检查、神经功能缺损情况等。比较两组患者基线、24h、7d、12周的神经功能缺损情况、早期改善及脑出血转化发生率和12周患者死亡率。结果两组患者基线美国国立卫生研究院卒中量表(NIHSS)评分差异无统计学意义。发病24h、7d后,溶栓组NIHSS改善分值(分别为11.1±10.1和9.0±9.9)与非溶栓组(分别为7.3±6.8和7.1±7.7)比较差异无统计学意义,但溶栓组早期改善百分比(分别为25.9%和48.1%)明显优于非溶栓组(均为0,P=0.01)。发病12周,溶栓组NIHSS改善分值与非溶栓组比较差异无统计学意义(P=0.69)。溶栓组出血转化情况:发病24h、7d后,溶栓组(11.1%)均高于非溶栓组(3.8%),但两组间比较差异无统计学意义(P=0.61)。发病12周,溶栓组与非溶栓组患者死亡例数分别为5例和6例(P=0.68)。结论 rtPA静脉溶栓治疗后循环脑梗死能够提高患者早期神经功能改善率;与非溶栓组比较,有增加出血转化的趋势及减少患者中远期死亡的风险。
Objective To evaluate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) in patients with recurrent cerebral infarction after intravenous thrombolysis. Methods A retrospective analysis method was used to select 53 patients with posterior circulation cerebral infarction within 6h after onset of disease from January 2010 to December 2014 in our hospital. Twenty-seven patients receiving rt-PA thrombolysis were thrombolytic group and did not accept Twenty-six patients who received thrombolysis and received only conventional anti-platelet aggregation or anticoagulant therapy were non-thrombolytic. The subjects were collected for age, gender, risk factors, past history, medication history, imaging and laboratory tests, neurological deficits and so on. Baseline, 24h, 7d, 12weeks of neurological deficit, early improvement, cerebral hemorrhage and 12-week mortality were compared between the two groups. Results There was no significant difference in baseline NIHSS score between the two groups. At 24 and 7 days after onset, there was no significant difference in NIHSS improvement scores (11.1 ± 10.1 and 9.0 ± 9.9, respectively) between thrombolysis group and non thrombolysis group (7.3 ± 6.8 and 7.1 ± 7.7, respectively), but thrombolysis The percentage of early improvement in the group (25.9% and 48.1%, respectively) was significantly better than the non-thrombolytic group (all 0, P = 0.01). At 12 weeks after onset, there was no significant difference between the NIHSS score and thrombolysis group (P = 0.69). In the thrombolytic group, the hemorrhagic transformation was notable (P = 0.61), but no significant difference was found between the two groups (P> 0.05). At 12 weeks after onset, the number of deaths in thrombolysis and non-thrombolysis groups were 5 and 6, respectively (P = 0.68). Conclusions Circulating cerebral infarction after rtPA intravenous thrombolysis can improve the improvement rate of early neurological function in patients. Compared with the non-thrombolytic group, there is an increasing trend of hemorrhage and conversion and reducing the risk of long-term death in patients.