摘要
目的探究动脉溶栓(IAT)能否改善非大血管性晚时间窗(4.5~24 h)急性缺血性卒中(AIS)患者的临床预后,评估IAT的安全性和有效性。方法收集2022年6月1日-2023年5月31日吉林省人民医院连续收治的急性非大血管性缺血性卒中患者资料。分为动脉内尿激酶溶栓组(UK组)和对照组(内科治疗)。主要终点事件为3个月良好的功能结果(改良Rankin评分0~1)。结果UK组共44例,对照组共40例。3个月的良好功能转归率,UK组和对照组的差异无统计学意义(80%vs 78%,P=0.820)。在3个月的随访中,UK组有更多的患者无卒中后遗症(57%vs 35%,P=0.045),并且在第2天时NIHSS评分改善明显者更多(P=0.025)。两组中均未发生症状性颅内出血。3个月内新发血管性事件,两组间差异无统计学意义(P=0.541)。结论针对急性非大血管性缺血性卒中患者,若发病时间在4.5~24 h内,使用尿激酶进行动脉溶栓,可能不仅获益于早期临床症状改善,还可能在90 d恢复期时完全无临床症状,且不良事件的发生率无明显升高。
Objective To investigate whether intra-arterial thrombolysis(IAT)can improve the clinical prognosis of acute ischemic stroke(AIS)patients without large vessel stenosis or occlusion in the late time window(4.5‒24 hours),as well as the safety and efficacy of IAT.Methods Related data were collected from AIS patients without large vessel stenosis or occlusion who were consecutively admitted to Jilin Provincial People’s Hospital from June 1,2022 to May 31,2023,and the patients were divided into UK group(intra-arterial urokinase thrombolysis)and control group(medical treatment).The primary endpoint event was a good functional outcome at 3 months(modified Rankin score 0‒1).Results There were 44 cases in the UK group and 40 cases in the control group.There was no significant difference in the rate of good functional outcome at 3 months between the UK group and the control group(80%vs 78%,P=0.820).During the follow-up for 3 months,compared with the control group,the UK group had a significantly higher proportion of patients without stroke sequelae(57%vs 35%,P=0.045)and a significantly higher proportion of patients with a remarkable improvement in NIHSS score on day 2(P=0.025).No symptomatic intracranial hemorrhage was observed in either group.There was no significant difference in new-onset vascular events within 3 months between the two groups(P=0.541).Conclusion For patients with acute non-macrovascular ischemic stroke,if the onset time is within 4.5‒24 hours,the use of urokinase for arterial thrombolysis may not only benefit from the improvement of early clinical symptoms,but also may be completely asymptomatic during the 90-day recovery period,and the incidence of adverse events is not significantly increased.
作者
李宗树
刘丽娟
王明宇
张亮
孙宏侠
LI Zongshu;LIU Lijuan;WANG Mingyu(Diagnosis and Treatment Center for Nervous System Diseases,Jilin Provincial People’s Hospital,Changchun 130021,China)
出处
《中风与神经疾病杂志》
CAS
2024年第11期1018-1023,共6页
Journal of Apoplexy and Nervous Diseases
基金
吉林省科技发展计划项目(202110203069SF)。
关键词
急性缺血性脑卒中
非大血管性
晚时间窗
动脉溶栓
Acute ischemic stroke
Non⁃large vessel stenosis or occlusion
Late time window
Intra-arterial thrombolysis
