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目的探讨阿替普酶(rt-PA)静脉溶栓治疗心源性脑栓塞的疗效和安全性。方法回顾性分析2012年6月至2016年1月收治的102例心源性脑栓塞患者的临床资料,分为3组,常规组34例常规治疗(包括抗血小板治疗),对照组34例给予低分子肝素抗凝治疗及常规用药(不包括抗血小板治疗),观察组(溶栓组)34例在时间窗内接受阿替普酶(rt-PA)静滴溶栓治疗及常规用药(溶栓24 h后加用抗血小板或抗凝药物)。比较3组治疗前后美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)及改良Rankin评分(MRS)。结果 3组治疗前基本临床资料比较差异无统计学意义(P>0.05);治疗后溶栓观察组NIHSS评分明显下降,BI、MRS上升,3组治疗后NIHSS评分、BI、MRS比较差异有统计学意义(P<0.05),其中2例出现无症状性脑出血。常规组和对照组治疗后NIHSS评分、BI、MRS与治疗前相比差异无统计学意义(P>0.05)。结论阿替普酶(rt-PA)静脉溶栓治疗心源性脑栓塞疗效显著,是安全的,可以在临床上推广。
Objective To investigate the efficacy and safety of intravenous thrombolytic therapy of alteplase (rt-PA) in the treatment of cardiogenic cerebral embolism. Methods The clinical data of 102 patients with cardiogenic cerebral embolism who were admitted from June 2012 to January 2016 were retrospectively analyzed and divided into three groups: 34 patients in conventional group (including antiplatelet therapy) and 34 patients in control group Low molecular weight heparin anticoagulant therapy and conventional medication (excluding antiplatelet therapy), 34 patients in the observation group (thrombolytic group) received intravenous thrombolytic therapy of alteplase (rt-PA) and routine medication Tied with anti-platelet or anticoagulant drugs after 24 h). The National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Modified Rankin Score (MRS) were compared between the three groups before and after treatment. Results There was no significant difference in the clinical data before treatment between the three groups (P> 0.05). After treatment, the NIHSS score of the thrombolytic observation group decreased significantly, while the BI and MRS levels increased. There were statistically significant differences in NIHSS score, BI and MRS between the three groups Significance (P <0.05), of which 2 cases of asymptomatic intracerebral hemorrhage. NIHSS score, BI, MRS after treatment in the conventional group and the control group were not significantly different from those before treatment (P> 0.05). Conclusion rt-PA intravenous thrombolytic therapy of cardiogenic cerebral embolism significant effect is safe and can be clinically promoted.