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目的探讨不同时间窗重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死患者的临床疗效。方法回顾性分析2013年10月—2015年10月收治的75例从发病至给药时间<4.5 h的急性脑梗死患者的临床资料,其中从发病至给药时间<3 h,且静脉给予rt-PA溶栓治疗患者24例(A组),发病至给药时间3~4.5 h,且静脉给予rt-PA溶栓治疗患者30例(B组),发病至给药时间<4.5 h未溶栓而常规治疗患者21例(对照组),分别在治疗前、治疗后24 h、7 d三个时间点分析比较其NIHSS评分,并在治疗后7 d对3组的临床疗效、颅内出血及死亡情况进行评估。结果 A组、B组治疗后24 h、7 d的NIHSS评分显著低于治疗前(t≥3.38,均P<0.05),也显著低于对照组治疗后(t≥3.42,均P<0.05);A组、B组治疗后24 h、7 d的NIHSS评分比较差异无统计学意义(t=0.81、0.99,均P<0.05)。A组、B组治疗后7 d的有效率显著高于对照组(χ~2=11.667、11.286,P<0.05),但A组、B组的有效率比较差异无统计学意义(χ~2=0.098,P>0.05)。A组、B组的病死率显著低于对照组(χ~2=3.780、4.989,P<0.05),但A组、B组的病死率比较差异无统计学意义(χ~2=0.026,P>0.05)。B组的颅内出血率显著高于A组,差异具有统计学意义(χ~2=3.881,P<0.05)。结论发病3~4.5 h和<3 h进行rt-PA溶栓临床疗效均显著,但时间窗的延长可导致颅内出血的风险增加,但死亡风险未增加,对发病4.5 h内的急性脑梗死患者应当积极给予rt-PA静脉溶栓治疗。
Objective To investigate the clinical effects of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute cerebral infarction at different time windows. Methods The clinical data of 75 patients with acute cerebral infarction who were admitted to our hospital from October 2013 to October 2015 were retrospectively analyzed. The clinical data of patients with acute cerebral infarction from onset to administration of less than 3 hours and intravenous administration of rt PA-thrombolytic therapy in 24 patients (group A), the onset time to the administration of 3 ~ 4.5 h, and intravenous administration of rt-PA thrombolytic therapy in patients with 30 cases (group B), the onset to the administration time <4.5 h undissolved (Control group). The NIHSS scores were compared before treatment, 24 h and 7 d after treatment, and the clinical efficacy, intracranial hemorrhage, The death was evaluated. Results The NIHSS scores of group A and group B at 24 h and 7 d after treatment were significantly lower than those before treatment (t ≥ 3.38, both P <0.05), but also significantly lower than those of the control group (t ≥ 3.42, P <0.05) There was no significant difference in NIHSS scores between groups A and B at 24 h and 7 d (t = 0.81, 0.99, all P <0.05). The effective rate of group A and group B after 7 days of treatment was significantly higher than that of control group (χ ~ 2 = 11.667,11.286, P <0.05), but there was no significant difference between group A and group B (χ ~ 2 = 0.098, P> 0.05). The mortality rates in group A and group B were significantly lower than those in control group (χ ~ 2 = 3.780, 4.899, P <0.05), but no significant difference was found between group A and group B (χ ~ 2 = 0.026, P > 0.05). The intracranial hemorrhage rate in group B was significantly higher than that in group A (χ ~ 2 = 3.881, P <0.05). Conclusions The curative effect of rt-PA thrombolysis is obvious at 3 ~ 4.5 h and <3 h after onset, but the prolonged time window may lead to an increased risk of intracranial hemorrhage, but the risk of death is not increased. For patients with acute cerebral infarction within 4.5 h Rt-PA should be actively given intravenous thrombolytic therapy.