急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓后疗效及安全性观察

摘要

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（字2=6.371，P＞0.05）。症状性脑出血总发生率7.8%（10/128），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（χ2=1.546，P＞0.05）。患者3个月内总体病死率14.1%（18/128），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（字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 assess the efficacy and safety of thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt- PA) for patients with acute cerebral infarction. Methods One hundred twenty eight patients with acute cerebral infarction received intravenous rt- PA thrombolytic therapy within 9h after onset; rt- PA therapy started 0~3.0, 3.0~4.5, 4.5~6.0 and 6.0~9.0h after onset of stroke in 44, 59, 14 and 11 cases, respectively. The efficacy was evaluated with modified Rankin Scale (mRS)at the 3rd month after onset of stroke;the symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months after onset of stroke were documented. Results The overall rate of good prognosis at the 3rd month was 37.5%(48/128), and that for 0~3.0 h, 3.0~4.5 h, 4.5~6.0 h and 6.0~9.0 h groups was 45.4% (20/44), 39.0% (23/59), 28.6% (4/14) and 9.1%(1/11) respectively(χ2=6.371, P>0.05).The overal incidence of symptomatic cerebral hemorrhage was 7.8%(10/128);that for 0~3.0 h, 3.0~4.5 h, 4.5~6.0 h and 6.0~9.0 h groups was 9.1%(4/44), 10.2%(6/59), 0.0%(0/14) and 0.0%(0/11) respectively. The overal mortality during 3 month after onset of stroke was 14.1%(18/128);that for 0~3.0h, 3.0~4.5h, 4.5~6.0h and 6.0~9.0h groups was 13.6%(6/44), 13.6%(8/59), 14.3%(2/14) and18.2%(2/11) respectively. Conclusion The efficacy of thrombolytic ther-apy within 3h after the onset of stroke is the best, delayed thrombolytic therapy may affect the efficacy. Thrombolytic therapy in-creases the incidence of symptomatic intracerebral hemorrhage. Multi- modal CT screening can help reduce the symptoms of cerebral hemorrhage.