摘要
目的 探讨不同时间窗重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗椎-基底动脉系统（VBA）脑梗死的临床疗效及安全性.方法 根据不同溶栓时间窗,对62例VBA脑梗死分为两组：＜4.5h组和4.5 ～6.0h组,各31例.采用rt-PA静脉溶栓治疗,比较不同时间窗及不同年龄组间溶栓的疗效及不良反应.结果 溶栓后,两组NIHSS评分均较溶栓前显著下降（P＜0.05）;＜4.5h组、4.5～6.0h组溶栓后各时间点NIHSS评分差异均无统计学意义（P＞0.05）;溶栓后,两组BI指数均较溶栓前显著升高（P＜0.05）;溶栓后90天,＜4.5h组BI指数显著高于4.5 ～6.0h组（P＜0.05）;4.5～6.0h组＜60岁患者的有效率47.1％,显著低于＜4.5h组有效率77.4％ （P ＜0.05）,而4.5 ～6.0h组年龄≥60岁患者与＜4.5h组总有效率比较,差异无统计学意义（P ＞0.05）;4.5h内溶栓不增加出血的风险,而4.5 ～6.0h溶栓中,年龄≥60岁患者出血的风险较低.结论 VBA脑梗死发病6h内使用rt-PA静脉溶栓治疗均是安全、有效的,4.5h内溶栓预后相对更好.对于发病4.5 ～6h的患者内不应轻易放弃溶栓治疗.
Objective To investigate the clinical efficacy and safety of recombinant tissue plasminogen activator （rt-PA） thrombolysis at different time window for vertebrobasilar system （VBA） cerebral infarction.Methods According to different thrombolysis time,62 patients were divided into two groups including ＜4.5h group （n =31） and 4.5-6.0h group （n =31）.All the patients were treated with rt-PA thrombolysis,and the clinical effect and side effect was analyzed between different time window and ages.Results The score of NIHSS in all patients was significant lower than that before treatment （P ＜ 0.05）,while there was no significant difference at different treatment points between two groups （P ＞ 0.05）.The index of BI in all patients was significant increased than that before treatment （P ＜ 0.05）,and it was remarkably higher in ＜ 4.5h group compared with that in 4.5 ～ 6.0h group at treatment for 90 days （P ＜ 0.05）.The effective rate in patients under 60 years old of 4.5 ～ 6.0h group was 47.1％,which was significant lower than 77.4％ in ＜ 4.5h group （P ＜ 0.05）,while there was no significant difference between over 60 years old of 4.5 ～6.0h group and ＜ 4.5h group（P ＞ 0.05）.Thrombolysis at ＜ 4.5h did not increase the risk of haemorrhagia,and there was lower risk of haemorrhagia for thrombolysis at 4.5 ～ 6.0h among patients over 60 years old.Conclusion It is safe and effective of rt-PA thrombolysis within 6 hours for VBA cerebral infarction,particularly within 4.5 hours.We should not easily give up the thrombolysis treatment opportunity for patients within 4.5 ～ 6.0h.
出处
《医学研究杂志》
2014年第4期164-167,共4页
Journal of Medical Research
关键词
椎-基底动脉系统
脑梗死
重组组织型纤溶酶原激活剂
溶栓
时间窗
Vertebrobasilar system
Cerebral infarction
Recombinant tissue plasminogen activator
Thrombolysis
Time window
