摘要
目的探讨轻型缺血性脑卒中静脉溶栓治疗后3h内早期口服抗血小板聚集治疗的疗效和安全性。方法选择发病4.5h内的急性脑梗死患者160例,随机分为2组:溶栓后3h内的早期抗血小板聚集治疗组(n=80)和溶栓24h后的标准治疗组(n=80),观察溶栓后第1d的早期神经功能恶化的发生率,第28d的美国国立卫生研究院卒中量表(NIHSS)评分、改良RANKIN量表(mRS)评分、出血发生率和病死率。结果溶栓后第1d早期抗血小板聚集治疗组早期神经功能恶化的总发生率与标准治疗组比较无明显差异(8.75%vs 15%,P=0.222),但血管再闭塞率明显低于标准治疗组(1.25%vs 8.75%,P=0.03);溶栓后第28d早期抗血小板聚集治疗组的NIHSS评分和mRS评分与标准治疗组比较无明显差异(P>0.05);2组的死亡例数均为0,脑出血和其他系统的出血发生率也无明显差异。结论轻型缺血性脑卒中静脉溶栓后早期抗血小板聚集治疗可能是安全的,而且能够降低早期血管再闭塞的风险。
Objective To evaluate the efficacy and safety of early administration of oral antiplatelet therapy within the third hour after recombinant tissue type plasminogen activator(rt-PA)treatment in patients with mild ischemic stroke.Methods One hundred and sixty patients with acute cerebral infarction(<4.5 hours from onset)were recruited and randomly allocated into 2 groups.80 patients were treated with oral antiplatelet within the third hour after the intravenous rt-PA administration,in the other 80 patients oral antiplatelet therapy started 24 hours after rt-PA treatment.The primary efficacy and safety endpoints were the early neurological deterioration in 1 st day after the thrombolysis,NIHSS scoring,modified Rankin scale(mRS),the hemorrhage and the death of the patients in 28 th day.Results There was no significant difference in the early neurological deterioration between two groups(8.75% vs 15%,P=0.222),but the reocclusion rate in the early antiplatelet administration group was significantly lower than that in the control group(1.25% vs8.75%,P=0.03).There was no significant difference in NIHSS scoring and mRS between two groups(P>0.05).The number of death in both groups were zero,no significant difference was found in cerebral hemorrhage and other systemic hemorrhage between two groups(P>0.05).Conclusion Administration of oral antiplatelet therapy within the third hour after patients with mild ischemic stroke treated with rt-PA was probably safe,and importantly it could reduce the risk of the early reocclusion.
作者
龚汉贤
李飞
罗丽霞
李卓卫
邹腾甜
杨晓洁
Gong Hanxian;Li Fei;Luo Lixia(Department of Neurology,Nanhai Hospital of Southern Medical University,Foshan 528200)
出处
《卒中与神经疾病》
2019年第1期43-46,共4页
Stroke and Nervous Diseases
