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阿替普酶静脉溶栓治疗急性脑梗死患者的临床疗效及预后的影响因素
韩臻臻,童燕娜,段洪连,张伟东
0
(首都医科大学附属北京潞河医院神经内科)
摘要:
目的 探讨阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死(ACI)患者的临床疗效,并对其预后的影响因素进行分析。方法 对我院2015年4月~2017年8月收治的120例ACI患者的临床资料进行回顾性分析,根据不同治疗方式分为对照组与观察组,每组各60例。对照组采取常规溶栓治疗,观察组在常规治疗的基础上实行静滴rtpA09mg/kg(≦50mg),于1h内滴注完,运用美国的NIHSS及Barthel指数(BI)分别对患者治疗前与治疗后7d、1个月时评分,评价神经功能恢复状况。记录患者临床疗效及不良反应发生情况,分析其影响预后的因素。结果 治疗后两组同一时间点NIHSS评分比较,差异有统计学意义(P<0.05),且随着治疗时间变长,NIHSS评分逐渐下降;治疗前,两组BI评分无明显差异(P>0.05),治疗后两组同一时间点,观察组BI评分明显高于对照组(P<0.05);观察组患者治疗总有效率(98.33%)明显高于对照组(83.33%)(X2=8.107,P=0.004);观察组不良反应发生率(5.00%)与对照组(3.33%)相比,差异无统计学意义(X2=0.209,P=0.648);单因素分析显示,年龄及治疗前NIHSS评分、心脏疾病及糖尿病、营养状况等因素对患者的预后有影响(P<0.05);进一步Logistic多因素回归分析后表示,治疗前NIHSS评分、心脏病及糖尿病史、营养状况及治疗方式均是影响患者预后治疗的独立危险因素(P<0.05)。结论 对ACI患者,采取rt-PA静脉溶栓治疗的临床疗效优于常规治疗,可明显地改善患者的神经功能,更具安全性,可更好地保障患者的预后,并且对于栓塞的治疗越早越好,患者的预后与病情轻重、年龄及糖尿病、心脏疾病和营养状况等因素有关。
关键词:  阿替普酶  静脉溶栓  急性脑梗死  临床疗效  预后因素
DOI:
基金项目:北京市自然科学基金(7122069)
Clinical efficacy and prognostic factors of acute cerebral infraction patients treated by intravenous thrombolytic therapy with alteplase
HAN Zhenzhen,TONG Yanna,DUAN Honglian,ZHANG Weidong
(Department of Neurology, Beijing Luhe Hospital Affiliated Capital Medical University)
Abstract:
Objective To investigate the clinical efficacy and prognostic factors of acute cerebral infraction (ACI) patients treated by intravenous thrombolytic therapy with alteplase (rtPA). Methods The clinical data of 120 ACI patients treated in our hospital from April 2015 to August 2017 were retrospectively analyzed and patients were divided into two groups, according to different treatment methods. The control group received the intravenous thrombolytic therapy. Based on the treatment of control group, the observation group received the intravenous injection and drip of 09mg/kg (≦50 mg) rtpA within 1h. The NIHSS and Barthel score were recorded. Then the clinical efficacy, adverse reactions and prognostic factors of the two groups were recorded and analyzed. Results The NIHSS score of the two groups at the same time point had significant difference (P<0.05), which were gradually decreased with the treatment time prolonged. The BI score had no difference before treatment (P>0.05), and they were higher in the observation group than in the control group after treatment at the same time point (P<005). The total effective rate in the observation group was significantly higher than that in the control group (9833% vs 8333%;X2=8.107, P=0.004). The incidence of adverse reactions in the observation group was not significantly different from that of the control group (500% vs 333%;X2=0.209, P=0.648). Univariate analysis showed age, pretreatment NIHSS scores, heart disease, diabetes, nutritional status and others were prognostic factors (P<0.05). Logistic multivariate regression analysis showed that NIHSS scores, history of heart disease and diabetes, nutritional status, and treatment modalities were all independent risk factors affecting the prognosis of patients (P<0.05). Conclusion The intravenous thrombolytic therapy with rtPA can effectively and safely guarantee the prognosis for ACI patients, and the prognosis of patients is related to the severity, age, diabetes, heart disease and nutritional status.
Key words:  rt-PA  Intravenous thrombolysis  ACI  Clinical efficacy  Prognostic factors

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