摘要
目的探讨发病4.5~6.0 h超阿替普酶时间窗的急性脑梗死(ACI)患者接受尿激酶静脉溶栓治疗的安全性及有效性。方法选取2017年6月至2020年10月该院收治的发病4.5~6.0 h的ACI患者168例,按不同治疗方法分为治疗组(尿激酶溶栓治疗)和对照组(抗血小板聚集治疗),每组84例。比较2组患者入院时,治疗后24 h、(7±2)d,出院当天美国国立卫生研究院卒中量表评分,以及出入院时改良Rankin量表及Barthel指数。采用logistic回归模型分析影响ACI患者尿激酶静脉溶栓疗效的危险因素。结果治疗组患者总有效率,以及治疗后24 h、(7±2)d,出院当天美国国立卫生研究院卒中量表评分,出院时改良Rankin量表评分及Barthel指数均明显优于对照组,差异均有统计学意义(P<0.05)。性别、年龄、吸烟、空腹血糖、总胆固醇、低密度脂蛋白、高血压、冠心病是直接影响ACI患者尿激酶静脉溶栓疗效的危险因素。2组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论在超阿替普酶静脉溶栓4.5~6.0 h时间窗给予尿激酶静脉溶栓治疗ACI患者是安全、有效的,有效降低了ACI患者致残率,改善预后,虽然尿激酶可能会增加静脉溶栓后出血风险,但出血率极低,值得临床推广应用。
Objective To investigate the safety and efficacy of urokinase intravenous thrombolysis in patients with acute cerebral infarction(ACI)whose onset time is 4.5 to 6.0 hours beyond the time window of alteplase.Methods A total of 168 ACI patients whose onset time was 4.5 to 6.0 hours admitted to this hospital from June 2017 to October 2020 were selected and divided into treatment group(urokinase thrombolysis therapy)and control group(antiplatelet aggregation therapy)according to different treatment methods,with 84 cases in each group.The scores of National Institutes of Health Stroke Scale(NIHSS),modified Rankin Scale(mRs)and Barthel Index(BI)were compared between the two groups at admission,24 hours and(7±2)days after treatment,and the day of discharge.The logistic regression model was used to analyze the risk factors of urokinase intravenous thrombolysis in patients with ACI.Results The total effective rate of the patients in the treatment group,as well as the scores of NIHSS at admission,24 hours and(7±2)days after treatment,and the day of discharge,and the scores of mRs and BI at discharge were significantly better than those in the control group,with statistically significant differences(P<0.05).Gender,age,smoking,fasting blood glucose,total cholesterol,low-density lipoprotein,hypertension,and coronary heart disease were the risk factors that directly affected the efficacy of urokinase intravenous thrombolysis in the patients with ACI(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Urokinase intravenous thrombolysis is safe and effective in the treatment of ACI patients whose onset time is 4.5 to 6.0 hours beyond the time window of intravenous thrombolysis with alteplase,which can effectively reduce the disability rate and improve the prognosis of ACI patients.Although urokinase may increase the risk of bleeding after intravenous thrombolysis,the bleeding rate is extremely low.Therefore,it is worthy of clinical application.
作者
杜兴梅
唐妍妍
DU Xingmei;TANG Yanyan(Department of Neurology,Yongzhou Central Hospital/School of Medicine,Jishou University,Jishou,Hunan 416000,China)
出处
《现代医药卫生》
2022年第24期4174-4177,4182,共5页
Journal of Modern Medicine & Health
关键词
超阿替普酶4.5~6.0
h急性脑梗死
尿激酶
静脉溶栓
Acute cerebral infarction beyond alteplase of 4.5 to 6.0 hours
Urokinase
Intravenous thrombolysis
