目的:观察阿替普酶(alteplase,rt-PA)在脑梗死4.5h内溶栓的有效性及安全性,分析影响静脉溶栓预后因素.方法:回顾2007-2012年台州一院和温州一院96例4.5h内静脉溶栓患者的资料,以NINDS研究和ECASS-3研究的资料作为本研究的对照.结果:对比经典试验,有统计学差异表明溶栓改善近期及长期预后,24h改善率达52.1％,3个月预后良好的比例为46.9％,虽然增加了颅内出血风险,但以非症状性颅内出血为主,且不增加总体死亡率.良好预后与基线NIHSS评分≤12和24h改善率相关.结论:只要严格掌握了溶栓的适应症和禁忌症,阿替普酶4.5h内静脉溶栓是有效且安全的,特别是轻、中度(NIHSS≤12)卒中患者获益最大；可明显改善脑梗死患者的预后；不良预后与基线卒中病情严重相关.%Objective: To observe the effectiveness and safety of alteplase used for thrombolysis within 4.5 h after cerebral infarction, and analyze factors influencing prognosis after intravenous thrombolytic therapy. Methods : The data of 96 patients with thrombolysis within 4. 5 h from Tai zhou first people's hospital and the first affiliated hospital of Wenzhou medical college between 2007 and 2012 were reviewed. NINDS research data and ECASS-3 research data were applied as the control for this research. Results; Compared with classical experiment, statistical significance showed thrombolysis improved recent and long-term prognosis. The 24-h improvement rate achieved 52. 1% , and the rate of good prognosis after three months achieved 46.9% . Although intracranial hemorrhage risk increased, asymptomatic intracranial hemorrhage was dominated, and the total death rate was not increased. According to the analyses, the mark of good prognosis and baseline NHHSS ≤12 were related with 24-hour improvement rate. Conclusion; As long as the indication and contraindication of thrombolysis are mastered strictly, alteplase for intravenous thrombolysis within 4. 5 h is effective and safe, especially for patients suffering light and moderate apoplexy (NIHSS≤12). The prognosis of patients with cerebral infarction can be improved, and the poor prognosis is greatly related to baseline apoplexy.
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