阿替普酶靜脈溶栓治療輕型缺血性卒中的臨床研究

王玉才 王會 張梅

[摘要] 目的 探討阿替普酶靜脈溶栓治療輕型缺血性卒中患者的安全性和90 d預后。 方法 選擇2015年10月～2018年9月在北京市順義區醫院神經內科收治的110例輕型急性缺血性卒中患者，根據是否行阿替普酶靜脈溶栓治療分為溶栓組和非溶栓組，其中溶栓組42例，非溶栓組68例。比較兩組溶栓后24 h美國國立衛生研究院卒中量表評分（NIHSS）、90 d改良Rankin評分及出血轉化發生率。 結果 非溶栓組基線NIHSS評分為（1.86±0.55）分，溶栓組基線NIHSS評分為（1.94±0.58）分，差異無統計學意義（P>0.05）。非溶栓組24 h NIHSS評分為（1.69±0.32）分，溶栓組24 h NIHSS評分為（0.95±0.23）分。與非溶栓組患者相比，溶栓組患者24 h NIHSS評分更低，差異有統計學意義（P<0.05）。溶栓組中，與溶栓前NIHSS評分比較，溶栓后24 h NIHSS評分更低，差異有統計學意義（P<0.05）。溶栓組發生出血轉化為2例（4.8%），非溶栓組發生出血轉化為3例（4.4%），差異無統計學意義（P>0.05）。兩組患者均未出現腦實質出血。溶栓組預后良好（mRS≤1分）的患者為38例（90.5%），預后不良（2≤mRS≤6分）的患者為4例（9.5%）;非溶栓組預后良好的患者為51例（75.0%），預后不良患者為17例（25.0%），差異有統計學意義（P<0.05）。 結論 輕型急性缺血性卒中患者在發病4.5h內進行阿替普酶靜脈溶栓有助于降低24 h NIHSS評分，改善90 d預后，并不增加出血轉化。

[關鍵詞] 輕型缺血性卒中;阿替普酶;溶栓

[中圖分類號] R743.3? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2019）09-0039-04

[Abstract] Objective To explore the safety and 90-day prognosis of alteplase intravenous thrombolytic therapy in patients with minor ischemic stroke. Methods 110 patients with minor acute ischemic stroke admitted to our hospital from October 2015 to September 2018 were divided into thrombolytic group and non-thrombolytic group according to whether they were treated with alteplase intravenous thrombolytic therapy. There were 42 patients in the thrombolytic group and 68 patients in the non-thrombolytic group. The 24 hours National Institutes of Health Stroke Scale score（NIHSS）， 90d modified Rankin score， and hemorrhagic transformation rate were compared after thrombolysis. Results The baseline NIHSS score of the non-thrombolytic group was（1.86±0.55） points， and the baseline NIHSS score of the thrombolytic group was（1.94±0.58） points. The difference was not statistically significant（P>0.05）. The NIHSS score of the non-thrombolytic group was（1.69±0.32） points at 24 h， and the NIHSS score at the 24 h of the thrombolytic group was（0.95±0.23） points. Compared with patients in the non-thrombolytic group， the 24 h NIHSS score was lower in the thrombolytic group， and the difference was statistically significant（P<0.05）. In the thrombolytic group， compared with the NIHSS score before thrombolysis， the NIHSS score was lower at 24 h after thrombolysis， and the difference was statistically significant（P<0.05）. Hemorrhagic transformation occurred in 2 patients（4.8%） in the thrombolytic group and 3 patients（4.4%） in the non-thrombolytic group. The difference was not statistically significant（P>0.05）. No brain parenchymal hemorrhage occurred in either group. In the thrombolytic group， 38 patients（90.5%） had a good prognosis（mRS≤1）， and 4 patients（9.5%） had a poor prognosis（2≤mRS≤6）. The patients with good prognosis in the non-thrombolytic group were 51 patients（75.0%）， and 17 patients（25.0%） had poor prognosis， and the difference was statistically significant（P<0.05）. Conclusion Intravenous thrombolysis with alteplase within 4.5 hours of onset of minor acute ischemic stroke helps to reduce the 24 h NIHSS score， improve the 90 d prognosis， and does not increase hemorrhagic transformation.