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目的观察重组组织型纤溶酶原激活剂 ( rt-PA)静脉溶栓早期治疗老年急性脑梗死的疗效和安全性。方法急性脑梗死 40例 (发病时间 <6小时 )分为两组 :≥ 70岁组 ( A组 15例 )和 <70岁组 ( B组 ,2 5例 )。选用艾通立 5 0 mg,先于 2分钟内静脉注射 rt-PA 8mg,再将 42 mg于 1小时内静脉泵入 ,两组其它治疗均相同。评定指标包括治疗前、治疗后 2 4小时、30天的临床神经功能缺损程度评分 ;治疗后 30天的 Barthel指数及死亡情况、副作用。结果治疗前、治疗后 2 4小时、30天的临床神经功能缺损程度评分 :A组分别为 18±2 .4、13.2± 3、6.9± 2 ;B组分别为 17.5± 2 .0、11.4± 2、6.8± 2 .5 ;两组比较无显著性差异 ( P>0 .0 5 ) ;30天时的 Barthel指数评分 :A组为 86.5± 9.0、B组为 85 .4± 8.0 ,两组比较无显著性差异 ( P>0 .0 5 ) ;两组溶栓治疗后 Fb水平比较无显著性差异 ( P>0 .0 5 ) ,没有增加出血事件及其它副作用。两组病死率分别为 13.3%、8.0 % ,两组比较无显著性差异 ( P>0 .0 5 )。结论急性脑梗死早期应用 rt-PA静脉溶栓治疗是安全有效的 ;高龄 (≥ 70岁 )患者接受 rt-PA治疗安全有效。应用 rt-PA静脉溶栓治疗急性脑梗死不是绝对禁忌 ,可在权衡利弊的情况下慎重应用
Objective To observe the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of senile acute cerebral infarction. Methods Forty patients with acute cerebral infarction (onset time <6 hours) were divided into two groups: ≥70 years old (15 cases in group A) and <70 years old (group B, 25 cases). Atactol 50 mg was used, intravenously rt-PA 8 mg intravenously within 2 minutes, and then 42 mg intravenously within 1 hour. The other treatments were the same in both groups. Assessments included scores of clinical neurological deficits before treatment, 24 hours and 30 days after treatment, Barthel index and death at 30 days after treatment, and side effects. Results Before treatment, the score of clinical neurological deficit at 24 hours and 30 days after treatment was 18 ± 2 .4 and 13.2 ± 3, 6.9 ± 2 in group A, 17.5 ± 2 and 11.4 ± 10 in group B (P> 0.05). The Barthel index score at 30 days was 86.5 ± 9.0 in group A and 85.4 ± 8.0 in group B. The difference between the two groups was not statistically significant (P> 0.05) There was no significant difference (P> 0.05). There was no significant difference in Fb levels between the two groups after thrombolysis (P> 0.05), no increase in bleeding events and other side effects. The case fatality rates of the two groups were 13.3% and 8.0% respectively, with no significant difference between the two groups (P> 0.05). Conclusion rt-PA intravenous thrombolysis is safe and effective in the early stage of acute cerebral infarction. It is safe and effective to treat rt-PA in elderly patients (≥70 years). The application of rt-PA intravenous thrombolytic therapy of acute cerebral infarction is not an absolute contraindication, can be carefully weighed in the case of pros and cons