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目的探讨重组组织型纤维蛋白溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的有效性及安全性。方法经行头颅CT,磁共振常规T1WI、T2WI,水抑制序列(FLAIR),弥散加权扫描(DWI)筛选符合溶栓标准的急性期脑梗死患者50例。32例予以rt-PA静脉溶栓治疗,方案0.9mg/kg,最大剂量90mg,将总剂量的10%在1min内静脉注射,其余持续60min静脉泵入,24h后行抗血小板聚集治疗,1次/d。对照组18例给予常规抗血小板聚集治疗。观察二组治疗后NHISS评分、Barthel指数(BI)与改良Rankin量表(mRS)评分情况,并记录患者死亡、继发出血等不良事件发生情况。结果溶栓组患者治疗后24h、14d、90d的NHISS评分较对照组明显下降;BI指数较对照组增加。90d随访时,BI指数和mRS评分溶栓组较对照组明显改善(P<0.05或P<0.01)。所有不良事件发生例数差异无统计学意义(P>0.05)。结论早期rt-PA静脉溶栓是治疗急性脑梗死有效和相对安全的方法。
Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction. Methods Fifty patients with acute cerebral infarction who were eligible for thrombolysis were screened by cranial CT, conventional magnetic resonance T1WI, T2WI, water suppression sequence (FLAIR) and diffusion weighted imaging (DWI). 32 cases were given rt-PA intravenous thrombolysis, program 0.9mg / kg, the maximum dose of 90mg, the total dose of 10% within 1min intravenous injection, the remaining 60min intravenous infusion of anti-platelet aggregation therapy after 24h, 1 / d. The control group of 18 patients given conventional anti-platelet aggregation therapy. The scores of NHISS, Barthel Index (BI) and Modified Rankin Scale (mRS) in both groups were observed after treatment. The occurrence of adverse events such as death and secondary hemorrhage were recorded. Results The scores of NHISS at 24h, 14d and 90d after thrombolytic therapy were significantly lower than those in control group; BI index was higher than that of control group. At the 90-day follow-up, the BI index and mRS scores were significantly improved in the thrombolytic group compared with the control group (P <0.05 or P <0.01). There was no significant difference in the number of all the adverse events (P> 0.05). Conclusion Early rt-PA intravenous thrombolysis is an effective and relatively safe method for the treatment of acute cerebral infarction.