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目的观察不同剂量和溶栓时间的阿替普酶治疗急性缺血性脑卒中的临床疗效和安全性。方法将220例急性缺血性脑卒中患者随机分为A组90例、B组90例和C组40例。A组予以阿替普酶0.6 mg·kg~(-1),静脉滴注,溶栓时间<30 min;B组予以阿替普酶0.6 mg·kg~(-1),静脉滴注,溶栓时间约60 min;C组予以阿替普酶0.9 mg·kg~(-1),静脉滴注,溶栓时间约60 min。溶栓治疗1 d后,所有患者均口服阿司匹林100 mg·d~(-1),qd,持续3个月。比较3组患者的美国国立卫生研究院卒中量表(NIHSS)评分和药物不良反应的发生情况。结果治疗后1 h,A、B、C组NIHSS评分分别为(7.11±0.83),(8.24±0.96),(8.32±1.38)分;治疗后1 d,A、B、C组NIHSS评分分别为(7.92±0.93),(8.92±1.03),(9.09±1.17)分;治疗后7 d,A、B、C组NIHSS评分分别为(6.63±0.77),(7.31±0.83),(7.36±0.88)分;治疗后30 d,A、B、C组NIHSS评分分别为(4.89±0.62),(5.62±0.76),(5.78±0.87)分;治疗后90 d,A、B、C组NIHSS评分分别为(3.53±0.58),(4.77±0.55),(4.69±0.61)分,A组与B、C组比较差异均有统计学意义(P<0.05),但B组和C组比较差异均无统计学意义(P>0.05)。治疗后90 d,A、B、C组的预后良好率分别为72.22%(65/90例),54.44%(49/90例),55.00%(22/40例),A组与B、C组比较差异均有统计学意义(P<0.05),但B组和C组比较差异均无统计学意义(P>0.05)。3组患者出现的药物不良反应以牙龈出血为主,A、B、C组的药物不良反应率分别为8.89%,12.22%,17.50%,差异均无统计学差异(P>0.05)。结论阿替普酶0.6 mg·kg~(-1),溶栓时间<30 min的方案治疗脑卒中的临床疗效显著,不仅不增加出血的风险,而且可以减轻患者的经济负担。
Objective To observe the clinical efficacy and safety of alteplase with different dosage and thrombolytic time in the treatment of acute ischemic stroke. Methods 220 patients with acute ischemic stroke were randomly divided into group A 90 cases, group B 90 cases and group C 40 cases. Group A received alteplase 0.6 mg · kg -1, intravenous drip, thrombolysis time <30 min, and group B received alteplase 0.6 mg · kg -1 intravenously The duration of the suppository was about 60 minutes. In group C, alteplase 0.9 mg · kg ~ (-1) was intravenously dripped and the thrombolysis time was about 60 minutes. One day after thrombolytic therapy, all patients were given aspirin 100 mg · d -1 qd for 3 months. The National Institutes of Health Stroke Scale (NIHSS) score and adverse drug reactions were compared between the three groups. Results At 1 h after treatment, the NIHSS scores of A, B and C groups were (7.11 ± 0.83) and (8.24 ± 0.96) and (8.32 ± 1.38) points respectively. At 1 d after treatment, the NIHSS scores of A, B and C groups were (7.92 ± 0.93), (8.92 ± 1.03) and (9.09 ± 1.17) points respectively. On the 7th day after treatment, NIHSS scores in group A, B and C were (6.63 ± 0.77), (7.31 ± 0.83) and (7.36 ± 0.88 ). NIHSS scores in group A, B and C were (4.89 ± 0.62) and (5.62 ± 0.76) and (5.78 ± 0.87) min after treatment, respectively. At 90 days after treatment, NIHSS scores in groups A, B and C (3.53 ± 0.58), (4.77 ± 0.55) and (4.69 ± 0.61) respectively. There was significant difference between group A and group B and group C (P <0.05), but the differences between group B and group C No statistical significance (P> 0.05). The good prognosis of group A, B and C were 72.22% (65/90 cases), 54.44% (49/90 cases) and 55.00% (22/40 cases) respectively at 90 days after treatment, and the good prognosis of group A, B and C (P <0.05). However, there was no significant difference between group B and group C (P> 0.05). Adverse drug reactions occurred in 3 groups were mostly gum bleeding. The adverse drug reaction rates in groups A, B and C were 8.89%, 12.22% and 17.50%, respectively, with no significant difference (P> 0.05). Conclusion The therapeutic effect of alteplase 0.6 mg · kg ~ (-1) and thrombolysis time <30 min in the treatment of stroke is significant, not only does not increase the risk of bleeding, but also reduce the economic burden on patients.