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目的回顾性分析重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗超急性期缺血性脑卒中近期预后,探讨其在基层综合性医院使用的有效性及安全性。方法采用回顾性分析,选择2012年4月~2014年9月在玉田县医院神经内科住院的急性缺血性脑卒中患者187例,根据治疗不同分为低剂量组60例(rt-PA 0.6mg/kg),标准剂量组57例(rt-PA 0.9mg/kg),对照为组70例(未行rt-PA,仅常规治疗)。系统采集所有患者病历资料,均完成28d及90d随访。以改良的Rankin量表(mRS)评分0~1分为预后良好,分析各组有效性和安全性是否存在差异。结果低剂量组、标准剂量组和对照组出院和28d随访时预后良好率比较,差异无统计学意义(30.0%vs 31.6%vs 18.6%,P=0.182;38.3%vs 45.6%vs 27.1%,P=0.092),低剂量组和标准剂量组90d时预后良好率明显高于对照组(50.0%vs 52.6%vs 32.9%,P=0.047)。低剂量组、标准剂量组和对照组出血发生率比较,差异有统计学意义(5.0%vs 10.5%vs 0%,P<0.05);低剂量组与标准剂量组出血发生率差异无统计学意义(P=0.314)。随访90d时,低剂量组、标准剂量组和对照组病死率比较,差异无统计学意义(5.0%vs 3.5%vs 4.3%,P>0.05)。结论 rt-PA静脉溶栓可改善缺血性脑卒中患者90d预后,降低患者残疾,但有一定出血风险,低剂量rt-PA较标准计量出血少。
Objective To retrospectively analyze the short-term prognosis of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with hyperacute ischemic stroke, and to explore the effectiveness and safety of intravenous thrombolytic therapy in general hospital. Methods A retrospective analysis was conducted to select 187 patients with acute ischemic stroke hospitalized in Department of Neurology, Yutian Hospital from April 2012 to September 2014. According to the treatment, 60 patients (rt-PA 0.6 mg / kg). The standard dose group was 57 (rt-PA 0.9 mg / kg) and the control group was 70 (no rt-PA, only conventional treatment). All patients were collected medical records, were completed 28d and 90d follow-up. The modified Rankin Scale (mRS) score of 0 to 1 was considered as good prognosis, and the differences in the validity and safety of each group were analyzed. Results There was no significant difference between the low dose group, the standard dose group and the control group at discharge and the good prognosis at 28d follow-up (30.0% vs 31.6% vs 18.6%, P = 0.182; 38.3% vs 45.6% vs 27.1%, P = 0.092). The good prognosis of low-dose group and standard-dose group at 90 d was significantly higher than that of the control group (50.0% vs 52.6% vs 32.9%, P = 0.047). There were significant differences in the incidence of hemorrhage between the low dose group, the standard dose group and the control group (5.0% vs 10.5% vs 0%, P <0.05). There was no significant difference in the incidence of hemorrhage between the low dose group and the standard dose group (P = 0.314). After 90 days of follow-up, there was no significant difference in mortality between the low dose group, the standard dose group and the control group (5.0% vs 3.5% vs 4.3%, P> 0.05). Conclusion rt-PA intravenous thrombolysis can improve the prognosis of ischemic stroke patients 90d, reduce the patient’s disability, but there is a certain risk of bleeding, low-dose rt-PA than the standard measurement of bleeding less.