摘要
目的比较不同重组人组织型纤溶酶原激活剂(rt-PA)治疗时机对急性脑梗死伴心房颤动患者临床疗效及出血事件的影响。方法选取湖北省荆门市第二人民医院2015年3月—2017年7月收治的急性脑梗死伴心房颤动患者107例,根据rt-PA静脉溶栓治疗时机不同分为A组57例和B组50例。在常规治疗基础上,A组患者于发病后3.0~4.5 h、B组患者于发病后3.0 h内行rt-PA静脉溶栓治疗。比较两组患者溶栓治疗前、溶栓治疗后24 h、溶栓治疗后7 d美国国立卫生研究院卒中量表(NIHSS)评分,溶栓治疗后24 h、7 d溶栓有效率,随访3个月两组患者预后;记录两组患者随访期间出血事件发生情况。结果两组患者溶栓治疗前和溶栓治疗后7 d NIHSS评分比较,差异无统计学意义(P>0.05);B组患者溶栓治疗后24 h NIHSS评分低于A组(P<0.05)。B组患者溶栓治疗后24 h、7 d溶栓有效率高于A组(P<0.05)。随访3个月,两组患者预后比较,差异无统计学意义(P>0.05)。两组患者随访期间出血性梗死和症状性脑出血发生率比较,差异无统计学意义(P>0.05);B组患者随访期间脑实质出血发生率低于A组(P<0.05)。结论发病后3 h内和发病后3.0~4.5 h行rt-PA静脉溶栓治疗急性脑梗死伴心房颤动患者的预后相近,但发病后3 h内行rt-PA静脉溶栓治疗能更迅速地改善患者神经功能、提高溶栓有效率、减少脑实质出血发生风险。
Objective To compare the impact of different therapeutic opportunities of rt-PA on clinical effect and bleeding events in acute cerebral infarction patients merged with atrial fibrillation.Methods A total of 107 acute cerebral infarction patients merged with atrial fibrillation were selected in the Second People's Hospital of Jingmen from March 2015 to July 2017,and they were divided into A group(n=57)and B group(n=50)according to the therapeutic opportunity of rt-PA.Based on conventional treatment,patients in A group received rt-PA for venous thrombolytic therapy from 3.0 to 4.5 hours after attack,while patients in B group received rt-PA for venous thrombolytic therapy within 3.0 hours after attack.NIHSS score before thrombolytic therapy,24 hours and 7 days after thrombolytic therapy,effective rate 24 hours and 7 days after thrombolytic therapy,and prognosis 3 months after follow-up were compared between the two groups,and incidence of bleeding events was recorded during follow-up.Results No statistically significant differences of NIHSS score was found between the two groups before thrombolytic therapy or 7 days after thrombolytic therapy(P>0.05),while NIHSS score in B group was statistically significantly lower than that in A group 24 hours after thrombolytic therapy(P<0.05).Effective rate in B group was statistically significantly higher than that in A group 24 hours and 7 days after thrombolytic therapy,respectively(P<0.05).No statistically significant differences of prognosis was found between the two groups 3 months after follow-up(P>0.05).No statistically significant differences of hemorrhagic infarction or symptomatic cerebral hemorrhage was found between the two groups during follow-up(P>0.05),while incidence of brain parenchyma hemorrhage in B group was statistically significantly lower than that in A group(P<0.05).Conclusion The prognosis is similar in acute cerebral infarction patients merged with atrial fibrillation treated by rt-PA for venous thrombolytic therapy from 3.0 to 4.5 hours or within 3.0 hours after attack,but rt-PA for venous thrombolytic therapy within 3.0 hours after attack can more quickly improve the neurological function,more effectively improve the effective rate and reduce the risk of brain parenchyma hemorrhage.
作者
张丹丹
ZHANG Dan-dan(The Second Department of Neurology,the Second People's Hospital of Jingmen,Jingmen 448000,China)
出处
《实用心脑肺血管病杂志》
2018年第2期54-57,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
脑梗死
心房颤动
重组人组织型纤溶酶原激活剂
治疗结果
疗效比较研究
Brain infarction
Atrial fibrillation
Recombinant human tissue type plasminogen activator
Treatment outcome
Comparative effectiveness research
