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目的研究血糖水平对阿替普酶(Recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗急性脑梗死患者疗效的影响。方法选择2013年1月—2014年12月急诊符合rt-PA静脉溶栓标准的84例脑梗死患者,采用美国国立卫生研究院卒中量表(NIH stroke scale,NIHSS)评分,以rt-PA溶栓后24 h NIHSS分值减少≥4分或神经功能缺损症状完全消失视为有效,观察溶栓前随机血糖,入院7 d后空腹血糖、餐后2 h血糖和Hb A1c等对溶栓疗效的影响。结果 rt-PA溶栓后24 h有效组溶栓前随机血糖、入院7 d后空腹血糖、餐后2 h血糖、Hb A1c平均值都比无效组低,其中空腹血糖平均值有显著性差异(P<0.05)。溶栓疗效随Hb A1c值升高而逐渐降低。糖尿病组或糖耐量异常组比血糖正常组溶栓疗效降低。溶栓前随机血糖在7~9 mmol·L?1时疗效佳。结论阿替普酶静脉溶栓疗效与血糖水平密切相关,Hb A1c值越高,rt-PA溶栓后24 h疗效越差,溶栓前控制患者血糖在7~9 mmol·L?1有助于提高rt-PA溶栓疗效。
Objective To study the effect of blood glucose level on the curative effect of intravenous thrombolytic therapy of recombinant tissue plasminogen activator (rt-PA) in patients with acute cerebral infarction. Methods Eighty-four patients with cerebral infarction who met the rt-PA thrombolysis standard from January 2013 to December 2014 were selected. The NIH Stroke Scale (NIHSS) score, The NIHSS score of ≥4 points after 24 h or the complete disappearance of neurological deficit were considered as effective. Random blood glucose before thrombolysis, fasting blood glucose, postprandial blood glucose at 2 h and Hb A1c influences. Results Random blood glucose was measured at 24 h after rt-PA thrombolysis. Fasting blood glucose, postprandial blood glucose at 2 h and mean Hb A1c at 7 d after admission were significantly lower than those in the ineffective group, with significant differences in mean fasting glucose P <0.05). Thrombolytic therapy with the Hb A1c value and gradually decreased. The diabetic group or impaired glucose tolerance group than normal blood glucose group thrombolytic therapy. Before thrombolysis random blood glucose in 7 ~ 9 mmol·L -1 effect is good. Conclusion The effect of intravenous thrombolytic therapy with alteplase is closely related to the blood glucose level. The higher the Hb A1c value, the poorer the therapeutic effect at 24 h after rt-PA thrombolysis is. The control of blood glucose level before thrombolysis is 7-9 mmol·L -1 To improve rt-PA thrombolysis.