论文部分内容阅读
目的探讨急性缺血性脑卒中患者应用重组组织型纤溶酶原激活剂(rt PA)进行溶栓治疗的临床疗效,并分析不同中国缺血性卒中亚型分型(CISS)与疗效的关系。方法采用回顾性研究方法,对神经内科2012年4月至2013年12月收治的194例急性缺血性脑卒中患者的病历及术后随访资料进行统计分析,根据入院后是否采用溶栓治疗分为溶栓组150例和非溶栓组44例,两组均采用常规基础治疗,溶栓组加用rt PA静脉溶栓治疗,比较两组患者的临床疗效差异,并分析溶栓组患者不同CISS分型的临床疗效差异。结果两组入院时的NIHSS评分差异无统计学意义(P>0.05),治疗后24 h、7 d、3个月、1年溶栓组患者的NIHSS评分值均显著低于非溶栓组(P<0.05,P<0.01)。溶栓组患者21例治疗后病情恶化,其中死亡12例;非溶栓组9例患者病情恶化,其中死亡3例;溶栓组患者的总有效率64.67%,显著高于非溶栓组的47.73%(P<0.05)。溶栓组的总有效率在穿支动脉疾病型(87.10%)、大动脉粥样硬化型(77.78%)、其他病因型(67.86%)分别高于心源性卒中型(34.38%)和病因不明型(47.83%,P均<0.05)。溶栓组中,穿支动脉疾病型、大动脉粥样硬化型、其他病因型的NIHSS评分减少率分别高于心源性卒中型和病因不明型患者(P均<0.05)。结论急性缺血性脑卒中患者采用rt PA进行静脉溶栓治疗能够提高临床疗效,不同CISS分型的溶栓疗效存在一定差异。
Objective To investigate the clinical efficacy of thrombolytic therapy with recombinant tissue plasminogen activator (rt PA) in patients with acute ischemic stroke and to analyze the relationship between different Chinese subtypes of ischemic stroke (CISS) and the curative effect . Methods A retrospective study was conducted to analyze the medical records and postoperative follow-up data of 194 patients with acute ischemic stroke admitted from April 2012 to December 2013 in Neurology. According to whether thrombolytic therapy 150 cases of thrombolysis group and 44 cases of non-thrombolysis group, both groups were treated with routine basic thrombolysis plus rt PA intravenous thrombolysis, the two groups were compared the clinical efficacy differences, and analysis of patients with thrombolysis different CISS classification of clinical efficacy differences. Results There was no significant difference in the NIHSS scores between the two groups (P> 0.05). NIHSS scores at 24 h, 7 d, 3 months and 1 year after thrombolytic therapy were significantly lower than those without thrombolysis P <0.05, P <0.01). Thrombolytic group of 21 patients after treatment, the condition deteriorated, of which 12 died; non-thrombolytic group of 9 patients worsened, of which 3 died; the total effective rate was 64.67% in patients with thrombolytic group was significantly higher than the non-thrombolytic group 47.73% (P <0.05). The total effective rate of thrombolysis group was higher than that of perinatal stroke type (87.10%), large atherosclerotic type (77.78%) and other etiological types (67.86%) than those of cardiogenic stroke type (34.38%) and unknown etiology (47.83%, P <0.05). In the thrombolysis group, the NIHSS scores of percutaneous arterial disease type, large atherosclerosis type and other etiology types were significantly higher than those of cardioembolic stroke type and etiological type (all P <0.05). Conclusion Intravenous thrombolysis with rt PA in patients with acute ischemic stroke can improve the clinical curative effect. The curative effect of thrombolytic therapy in different CISS types is different.