摘要
目的探讨不同时机下重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合依达拉奉右崁醇治疗超高龄(年龄≥85岁)中重度急性缺血性脑卒中(AIS)疗效和安全性的差异。方法前瞻性选择南开大学附属第四中心医院神经内科自2020年12月至2023年3月采用rt-PA静脉溶栓联合依达拉奉右莰醇治疗的71例超高龄中重度AIS患者,采用随机数字表法将患者分为早期组(35例)和晚期组(36例),其中早期组患者在rt-PA静脉溶栓启动后即刻给予依达拉奉右崁醇治疗,晚期组患者在rt-PA静脉溶栓24 h后给予依达拉奉右崁醇治疗。另外选择该院神经内科自2018年8月至2020年12月采用单纯rt-PA静脉溶栓治疗的31例超高龄中重度AIS患者作为对照组。比较3组患者间疗效及安全性评价指标的差异。结果治疗后7 d,早期组患者的神经功能改善率高于对照组和晚期组,差异有统计学意义(P<0.05)。治疗后90 d,早期组患者的改良Rankin量表(mRS)评分低于对照组和晚期组,差异有统计学意义(P<0.05);早期组患者的预后良好率高于对照组和晚期组,差异有统计学意义(P<0.05)。早期组患者的颅内出血发生率和症状性颅内出血发生率低于对照组和晚期组,差异有统计学意义(P<0.05)。治疗后30 d、90 d,晚期组患者的病死率虽低于对照组,但高于早期组,差异均有统计学意义(P<0.05)。结论rt-PA静脉溶栓后即刻联合应用依达拉奉右崁醇是最佳时机,可提高rt-PA静脉溶栓治疗超高龄中重度AIS的疗效和安全性。
Objective To investigate the efficacy and safety of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis combined with edaravone dexborneol at different timing in super elderly patients(aged≥85 years)with moderate to severe acute ischemic stroke(AIS).Methods A prospective study was performed.Seventy-one super elderly patients with moderate to severe AIS treated with rt-PA intravenous thrombolysis combined with edaravone dexborneol from December 2020 to March 2023 in Department of Neurology,Affiliated Fourth Central Hospital of Nankai University were selected and randomly divided into early group(n=35)and advanced group(n=36);patients in the early group were given edaravone dexborneol immediately after rt-PA intravenous thrombolysis,and patients in the advanced group were given edaravone dexborneol 24 h after rt-PA intravenous thrombolysis.In addition,31 patients with moderate to severe AIS received rt-PA intravenous thrombolysis only in Department of Neurology of the hospital from August 2018 to December 2020 were selected as control group.Differences in efficacy and safety indexes among the 3 groups were compared.Results After 7 d of treatment,the improvement rate of neurological function in early group was significantly higher than that in control group and advanced group(P<0.05).After 90 d of treatment,modified Rankin scale(mRS)scores in early group were statistically lower than those in control group and advanced group(P<0.05);good prognosis rate in early group was statistically higher than that in control group and advanced group(P<0.05).The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in early group were significantly lower than those in control group and advanced group(P<0.05).After 30 and 90 d of treatment,the advanced group had significantly lower mortality than the control group,but significantly higher mortality than the early group(P<0.05).Conclusion Edaravone dexborneol immediately after rt-PA intravenous thrombolysis is the optimal timing for sup
作者
谷亚伟
楚旭
赵路静
洪波
高静珍
陈念
李强
董银华
王洪新
王利军
Gu Yawei;Chu Xu;Zhao Lujing;Hong Bo;Gao Jingzhen;Chen Nian;Li Qiang;Dong Yinhua;Wang Hongxin;Wang Lijun(Department of Neurology,Affiliated Fourth Central Hospital of Nankai University,Tianjin 300140,China;Medical Department,Baoding Xushui District People's Hospital,Baoding 072550,China;Department of Emergency Medicine,Affiliated Fourth Central Hospital of Nankai University,Tianjin 300140,China;Department of Neurology,Ninghe District Hospital of Tianjin,Tianjin 301500,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2023年第9期884-890,共7页
Chinese Journal of Neuromedicine
基金
天津市卫生健康科技项目(ZC20073)
南开大学附属第四中心医院2022年度优秀青年人才培养基金(tjdszxyy20220012)。
