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目的:探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗超早期脑梗死合并心房颤动(AF)的疗效及安全性。方法:对29例发病<3h的脑梗死合并AF患者分为溶栓组16例和对照组13例。溶栓组给予rt-PA总量0.9mg/kg,最大剂量90mg静脉溶栓。对照组予常规治疗。观察比较两组治疗前及治疗后(1h,24h,7d,21d)时的美国国立卫生院卒中量表(NIHSS)评分,以及治疗前、治疗后90d日常生活能力Barthal指数(BI)评分,早期神经功能改变情况,出血风险,死亡率。结果:溶栓组较对照组在治疗后1h,21d的NIHSS评分,90dBI评分均有改善(P<0.05);溶栓组较对照组早期神经功能改善有统计学差异(P<0.05);溶栓组出血事件的发生率高于对照组(P<0.05),不增加死亡事件。结论:rt-PA静脉溶栓治疗超早期脑梗死合并AF可改善早期神经功能缺损症状和预后。
Objective: To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of patients with very early cerebral infarction complicated with atrial fibrillation (AF). Methods: Twenty-nine patients with cerebral infarction <3h with AF were divided into thrombolytic group (n = 16) and control group (n = 13). Thrombolytic group given rt-PA total 0.9mg / kg, the maximum dose of 90mg intravenous thrombolysis. Control group to conventional treatment. The National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment (1h, 24h, 7d, 21d) were compared between two groups before and after treatment, Barthel index (BI) Neurological changes, bleeding risk, mortality. Results: Compared with the control group, the NIHSS score and 90dBI score of the thrombolysis group were significantly improved at 1h and 21d after treatment (P <0.05); the neurological function of the thrombolytic group was significantly different from that of the control group (P <0.05) The incidence of hemorrhage in the suppository group was higher than that in the control group (P <0.05), without increasing the death rate. Conclusion: rt-PA intravenous thrombolysis in the treatment of ultra-early cerebral infarction with AF can improve the symptoms and prognosis of early neurological deficits.