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目的:观察重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗超急性期脑梗死的临床疗效。方法:将2010年1月至2011年5月深圳市龙岗区第二人民医院收治的50例超急性期脑梗死患者,分为研究组(30例)和对照组(20例)。对照组常规应用抗血小板聚集药物、调脂稳定斑块、抗脑缺血,同时控制血压和血糖等;研究组在常规治疗的基础上,应用rt-PA静脉溶栓,剂量为0.9 mg/kg,最大剂量90 mg。治疗前后进行美国国立卫生院神经功能缺失(NIHSS)评分、改良Rankin评分和日常生活能力Barthal指数(BI)评分,并观察疗效、不良反应和预后。结果:对照组患者治疗后90 d,NIHSS评分由(11.85±1.30)分下降为(8.92±4.53)分,改良.Rankin评分临床转归良好7例(35%);脑出血1例,症状性出血转化率5%;死亡2例,病死率10%。研究组患者治疗后90 d,NIHSS评分由(11.80±2.23)分下降为(5.38±3.77)分,较对照组明显下降(P=0.008);改良Rankin评分临床转归良好16例(53%);出血转化8例,其中1例为症状性出血转化,症状性出血转化率为3%;死亡3例,病死率10%。结论:早期rt-PA静脉溶栓治疗发病4.5 h内的急性脑梗死安全有效,并可以改善远期预后。
Objective: To observe the clinical effect of intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) in the treatment of hyperacute cerebral infarction. Methods: From January 2010 to May 2011, 50 patients with hyperacute cerebral infarction admitted to Second People’s Hospital of Longgang District of Shenzhen City were divided into study group (30 cases) and control group (20 cases). In the control group, anti-platelet aggregation drug, lipid-stabilizing plaque, anti-cerebral ischemia, blood pressure and blood glucose control were routinely used in the control group. On the basis of routine treatment, the study group was given rt-PA intravenous thrombolysis at a dose of 0.9 mg / kg , The maximum dose of 90 mg. National Institutes of Health neurological deficit (NIHSS) score, modified Rankin score and Barthal index (BI) scores of daily living ability were measured before and after treatment. The curative effect, side effects and prognosis were observed. Results: In the control group, the NIHSS score decreased from (11.85 ± 1.30) points to (8.92 ± 4.53) points at 90 days after treatment, and improved in the control group.7 cases (35%) had good clinical outcomes of Rankin score, 1 case had cerebral hemorrhage, Hemorrhage conversion rate of 5%; 2 cases of death, case fatality rate of 10%. The NIHSS score decreased from (11.80 ± 2.23) points to (5.38 ± 3.77) points in the study group at 90 d after treatment, which was significantly lower than that in the control group (P = 0.008). The modified Rankin score had good clinical outcomes in 16 patients (53% ; 8 cases of hemorrhage transformation, 1 case of symptomatic hemorrhagic transformation, symptomatic hemorrhage conversion rate of 3%; 3 cases of death, the case fatality rate of 10%. Conclusions: Early rt-PA intravenous thrombolysis is safe and effective in treating acute cerebral infarction within 4.5 hours of onset and can improve long-term prognosis.