不同时间窗阿替普酶静脉溶栓治疗急性脑梗死的效果及对患者神经功能缺损、外周血D-二聚体、纤维蛋白原水平的影响

摘要

Objective To observe the efficacy of intravenous thrombolytic therapy with alteplase ( rt-PA) in different time windows in the treatment of acute cerebral infarction ( ACI) and its influence on neurological function , blood D-dimer ( D-D) and fibrinogen ( Fib) levels.Methods Sixty patients with ACI treated with rt-PA intravenous thrombolysis in Yongji People's Hospital from May 2015 to May 2018 were selected as research objects .According to the time windows , they were divided into group A and group B, with 30 cases in each group.Patients in group A were treated by thrombolytic therapy within 3.0 hours after onset , and patients in group B were treated by thrombolytic therapy at 3.0 h to 4.5 h after onset.The National Institutes of Health Stroke scale (NIHSS) scores, D-D and Fib levels of the two groups were observed , and the efficacy and safety of the two groups were compared .Results There were no significant difference in NIHSS scores between the two groups before and 24 h, 7 d after thrombolytic therapy ( P>0.05) .There was no significant difference in the levels of D-D and Fib between the two groups before and after thrombolytic therapy ( P>0.05) .The total effective rate and incidence of adverse reactions of group A were not different from those of group B ( P>0.05 ) .Conclusions There is no significant difference in the effects of rt-PA intravenous thrombolytic therapy within 3.0 hours after onset and at 3.0 h to 4.5 h after onset on neurological function , peripheral blood D-D and Fib levels in patients with ACI .The efficacy and safety of the two protocols are similar .%目的 观察不同时间窗阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死(ACI)的效果及对患者神经功能、血D-二聚体(D-D)及纤维蛋白原(Fib)水平的影响.方法 选取2015年5月至2018年5月于永济市人民医院接受rt-PA静脉溶栓治疗的ACI患者60例,根据治疗时间窗分为A组及B组,每组30例.A组于发病3.0 h内接受溶栓治疗,B组于发病3.0～4.5 h接受溶栓治疗.观察两组美国国立卫生研究院卒中量表(NIHSS)评分、D-二聚体及Fib水平的变化,比较两组疗效及安全性.结果 溶栓治疗前、溶栓治疗后24 h及7 d两组NIHSS评分比较差异均未见统计学意义(P均>0.05),两组溶栓治疗前后D-二聚体及Fib水平比较差异未见统计学意义(P>0.05),两组临床总有效率及不良反应发生率比较差异未见统计学意义(P>0.05).结论 ACI患者发病后3.0～4.5 h行rt-PA静脉溶栓治疗与发病后3.0 h内行溶栓治疗对患者神经功能、外周血D-二聚体及Fib水平影响无明显差异,二者疗效及安全性接近.