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目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗颈内动脉系统急性脑梗死的疗效及安全性,并评估不同TOAST分型急性脑梗死的疗效差异。方法选择颈内动脉系统急性脑梗死患者51例,分为溶栓组33例(其中起病3 h内者25例,3～4.5 h者8例)和对照组18例,溶栓组予rt-PA0.9 mg/kg静脉溶栓,对照组予常规治疗。观察比较两组患者治疗前、治疗后(2 h、24 h、7 d、90 d)的神经功能缺损程度(NIHSS)评分以及治疗前、治疗后(7 d、90 d)的Barthel指数(BI),并将3 h溶栓组按TOAST分型分亚组进行分层分析。结果①3 h溶栓组治疗后2 h、24 h、7 d的NIHSS评分与治疗后7d、90 d的BI均较治疗前有统计学差异(P<0.05),且与对照组比较90 d的BI有统计学差异(P<0.05);②3～4.5 h溶栓组治疗后7 d NIHSS评分和90 d后BI较治疗前有统计学差异(P<0.05),且与对照组比较24 h、7 d NIHSS评分与90 d BI有统计学差异(P<0.05);③3 h溶栓组亚组分析提示大动脉粥样硬化组(LAA组)治疗后2 h、治疗后7 d的NIHSS评分与治疗后90 d的BI评分较治疗前有统计学差异(P<0.05);心源性栓塞组(CE组)治疗后2 h的NIHSS评分与90 d的BI评分较治疗前有统计学差异(P<0.05);小动脉闭塞组(SAA组)治疗后的NIHSS评分与治疗后BI评分均较治疗前无统计学差异(P>0.05);④3 h溶栓组出血事件的发生率高于对照组(P<0.05),而出现脑疝、死亡等不良事件的发生率相当(P>0.05)。亚组分析显示CE组的出血事件发生率高于LAA组和SAA组(P<0.05)。结论3 h内rt-PA静脉溶栓治疗可显著改善神经功能缺损症状和预后,出血风险较对照组增加。小样本3～4.5 h溶栓病例也取得了较好的临床疗效。3 h溶栓组亚组分析显示LAA组疗效优于CE组,而SAA组疗效欠佳。CE组的出血风险高于LAA组和SAA组。
Objective To investigate the efficacy and safety of intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction in the internal carotid artery system and to evaluate the efficacy of different types of TOAST acute cerebral infarction. Methods Fifty-one patients with acute cerebral infarction in the internal carotid artery system were divided into thrombolytic group, 33 cases (25 cases within 3 h, 8 cases, 3 to 4.5 h) and 18 cases in the control group. Thrombolytic group -PA0.9 mg / kg intravenous thrombolysis, the control group to conventional treatment. The NIHSS scores before and after treatment (2 h, 24 h, 7 d, 90 d) were compared between the two groups before and after treatment (7 d, 90 d). The Barthel index ), And 3 h thrombolysis group by TOAST classification sub-sub-layer analysis. Results ① The NIHSS scores at 2 h, 24 h and 7 d after 3 h treatment were significantly different from those at 7 d and 90 d after treatment (P <0.05), and compared with the control group at 90 d (P <0.05). ②The NIHSS score at 7th day after thrombolysis group was significantly different from that before treatment (P <0.05) at 3 ~ 4.5 hours after thrombolysis group, and after 24 hours, (P <0.05); (3) The 3-h thrombolytic group subgroup analysis suggested that NIHSS score and treatment at 2-hour and 2-week post-treatment in the group of Atherosclerosis (LAA) The score of BI after 90 days was significantly higher than that before treatment (P <0.05). NIHSS score of 2 h after cardiac embolism group (CE) and BI score of 90 d were significantly higher than those before treatment (P <0.05). There was no significant difference in NIHSS score and post-treatment BI score between the SAA group and the control group (P> 0.05). The incidence of bleeding events in the thrombolytic group at 3 h was higher than that in the control group (P <0.05). The incidence of adverse events such as hernia and death was similar (P> 0.05). Subgroup analysis showed that the incidence of bleeding in CE group was higher than that in LAA group and SAA group (P <0.05). Conclusion rt-PA intravenous thrombolysis can significantly improve the symptoms and prognosis of neurological deficits within 3 h, and the risk of bleeding is increased compared with that of the control group. Small sample 3 ~ 4.5 h thrombolytic cases also achieved good clinical efficacy. Subgroup analysis of 3 h thrombolysis group showed that LAA group had better curative effect than CE group, while SAA group had poor curative effect. The bleeding risk in CE group was higher than that in LAA group and SAA group.