CT指导超时间窗脑梗死患者阿替普酶静脉溶栓疗效观察

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摘要目的探讨CT指导超时间窗脑梗死患者阿替普酶静脉溶栓的临床疗效。方法选取2015年10月～2018年3月我院急诊科收治的56例发病时间在6 h内的给予静脉溶栓的急性脑梗死患者作为研究对象，依据患者发病至开始用药时间的长短分为A、B两组，A组为时间窗内（＜4.5 h）溶栓组（30例），B组为超时间窗（4.5～6.0 h）溶栓组（26例），均给予重组人组织纤维蛋白溶酶原激活剂（rt-PA）标准剂量静脉溶栓，B组溶栓前给予多模CT检查，静脉溶栓24 h后两组患者均复查常规头颅CT，并记录两组患者的不同时间节点的NIHSS评分与不良反应。结果 A 组患者治疗后的 NIHSS 评分[（3.8±1.8）分]低于治疗前[（11.6±3.2）分]，差异有统计学意义（P＜0.05）；B 组患者治疗后的 NIHSS 评分[（4.5±2.7）分]低于治疗前[（13.1±2.3）分]，差异有统计学意义（P＜0.05）；A 组患者治疗后 7 d的NIHSS评分低于B组，差异有统计学意义（P＜0.05）；两组患者的不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论应用多模式CT指导下静脉超时间窗溶栓能有效增加脑血流灌注，促进神经系统功能缺失的恢复，并且是安全的。

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	廖祥明

关键词 ：重组组织纤维蛋白溶酶原激活剂, 急性缺血性脑卒中, 超时间窗

Abstract：Objective To study the clinical effect of thrombolytic therapy with Alteplase for patients with acute extending thrombolytic time window cerebral infarction guided by CT.Methods From October 2015 to March 2018,56 patients with acute ischemic stroke and reached hospital within 6 hours and received intravenous thrombolysis treated in Department of Emergency of our hospital were selected as the subjects.They were divided into group A and group B by the onset to treatment time.Group A was rt-PA therapy started 0～4.5 h (30 cases),group B was rt-PA therapy started 4.5～6.0 h (26 cases).They all received standard dose intravenous rt-PA thrombolytic therapy,the patient of group B received multimodal CT.The patients of the two group patients have a normal CT scan in 24 h after intravenous thrombolysis.The NIHSS score at different time and the adverse effects were recorded.Results The NIHSS scores after intravenous thrombolysis([3.8±1.8]points)were lower than that before intravenous thrombolysis([11.6±3.2]points)in group A,the difference was statistically significant(P＜0.05).The NIHSS scores after intravenous thrombolysis ([4.5±2.7]points)were lower than that before intravenous thrombolysis([13.1±2.3]points)in group B,the difference was statistically significant(P＜0.05).The NIHSS scores after 7 d treatment in group A was lower than that in group B,the difference was statistically significant(P＜0.05).There was no statistical significance in the adverse effects incidence between the two groups.Conclusion Intravenous thrombolysis with rt-PA in patients with acute extending thrombolytic time window cerebral infarction guided by CT can significantly improve the blood perfusion,promote the recovery of neurological function,and is safety.

Key words： Tissue plasminogen activator Acute cerebral infarction Extending thrombolytic time window

作者简介: 廖祥明（1981-），男，江西赣州人，主治医师，研究方向：急性脑血管病诊治

引用本文:

廖祥明. CT指导超时间窗脑梗死患者阿替普酶静脉溶栓疗效观察[J]. 中国当代医药, 2018, 25(27): 65-67.
LIAO Xiang-ming. Efficacy observation of thrombolytic therapy with Alteplase for patients with acute extending thrombolytic time window cerebral infarction guided by CT. 中国当代医药, 2018, 25(27): 65-67.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2018/V25/I27/65

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