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目的分析重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死患者的有效性和安全性。方法 128例在发病9.0h内接受rt-PA静脉溶栓治疗的急性脑梗死患者,按发病到治疗的时间(OTT)分为A组(0~3.0h)、B组(3.0~4.5h)、C组(4.5~6.0h)、D组(6.0~9.0h)4组,其中OTT>4.5h的共25例,均采用多模式CT筛选。有效性指标采用发病后3个月时的改良Rank评分(mRS),0~1分定义为预后良好,安全性指标采用患者发病后36.0h内症状性脑出血的发生率和3个月内病死率。结果 128例患者总体预后良好率为37.5%(48/128),A~D组预后良好率分别为45.4%(20/44)、39.0%(23/59)、28.6%(4/14)、9.1%(1/11),4组间比较无统计学差异(x~2=6.371,P>0.05)。症状性脑出血总发生率7.8%(1 0/128),A~D组分别为9.1%(4/44)、10.2%(6/59)、0.0%(0/14)、0.0%(0/11),4组间比较无统计学差异(x~2=1.546,P>0.05)。患者3个月内总体病死率14.1%(1 8/128),A~D组分别为13.6%(6/44)、13.6%(8/59)、14.3%(2/14)、18.2%(2/11),4组间比较无统计学差异(x~2=0.102,P>0.05)。结论发病3.0h内使用rt-PA溶栓有效性最好,OTT延长则有效性降低。溶栓增加症状性脑出血发生率,多模式CT筛选可能有助于减少症状性脑出血发生率。
Objective To analyze the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute cerebral infarction. Methods A total of 128 patients with acute cerebral infarction treated with intravenous thrombolytic therapy of rt-PA within 9.0 hours of onset were divided into group A (0-3.0h) and group B (3.0-4.5h) according to the onset to treatment time (OTT) , Group C (4.5-6.0h) and group D (6.0-9.0h). Among them, 25 patients with OTT> 4.5h were screened by multi-mode CT. The validity index is based on the Modified Rank Rating (mRS) at 3 months after onset, with a well-defined prognosis of 0 to 1. The safety index is based on the incidence of symptomatic intracerebral hemorrhage within 36.0 hours of onset and within 3 months rate. Results The good overall prognosis of 128 patients was 37.5% (48/128). The good prognosis of A ~ D group was 45.4% (20/44), 39.0% (23/59), 28.6% (4/14) 9.1% (1/11). There was no significant difference among the 4 groups (x ~ 2 = 6.371, P> 0.05). The total incidence of symptomatic intracerebral hemorrhage was 7.8% (10/128) in the group A, while it was 9.1% (4/44), 10.2% (6/59), 0.0% (0/14), 0.0% (0 / 11). There was no significant difference among the 4 groups (x ~ 2 = 1.546, P> 0.05). The overall mortality was 14.1% (18/128) in patients within 3 months, 13.6% (6/44), 13.6% (8/59), 14.3% (2/14), 18.2% 2/11). There was no significant difference between the 4 groups (x ~ 2 = 0.102, P> 0.05). Conclusions The best use of rt-PA thrombolysis within 3.0 hours of onset and the prolongation of OTT are less effective. Thrombolysis increases the incidence of symptomatic cerebral hemorrhage, multi-mode CT screening may help reduce the incidence of symptomatic cerebral hemorrhage.