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目的比较不同剂量阿替普酶治疗急性缺血性脑卒中的效果,探讨治疗急性脑卒中的最佳剂量。方法将符合静脉溶栓指征的急性缺血性脑卒中患者120例随机分为2组,每组60例,观察组给予标准计量(0.9mg/kg)阿替普酶静脉溶栓治疗,对照组给予低剂量(0.6mg/kg)阿替普酶静脉溶栓治疗,比较2组患者治疗前及治疗后24h和72h美国国立卫生研究院卒中患者神经功能缺损评分量表(NIHSS)评分,随访3个月采用改良Rankin量表(mRS)评估患者预后,比较2组患者临床疗效及病死率。结果治疗后2组患者NIHSS评分均显著改善(P<0.05),2组比较差异均无统计学意义(P>0.05);2组患者总有效率、症状性颅内出血发生率及90d病死率比较差异均无统计学意义(P>0.05),但观察组90d良好预后率显著高于对照组(P<0.05)。结论标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗急性缺血性脑卒中具有更好的有效性,且未增加SICH风险,值得临床推广应用。
Objective To compare the effects of different doses of alteplase on acute ischemic stroke and to explore the best dosage for acute stroke. Methods A total of 120 acute ischemic stroke patients who were eligible for intravenous thrombolysis were randomly divided into two groups (n = 60 in each group). The observation group received standard therapy (0.9 mg / kg) Group were given low dose (0.6mg / kg) of alteplase intravenous thrombolytic therapy, compared two groups of patients before treatment and 24h and 72h after treatment, the National Institutes of Health Stroke Neurological deficit score scale (NIHSS) score, follow-up At 3 months, the prognosis was evaluated by modified Rankin Scale (mRS), and the clinical efficacy and mortality were compared between the two groups. Results The NIHSS scores of two groups were significantly improved after treatment (P <0.05), but there was no significant difference between the two groups (P> 0.05). The total effective rate, the incidence of symptomatic intracranial hemorrhage and the 90-day mortality rate (P> 0.05). However, the good prognosis of the observation group at 90 d was significantly higher than that of the control group (P <0.05). Conclusion The standard dose (0.9mg / kg) of alteplase intravenous thrombolysis in the treatment of acute ischemic stroke is more effective and does not increase the risk of SICH, it is worthy of clinical application.