Efficacy ofintravenousthrombolysiswithrt-PAinpeoplewithAcuteMildIschemicStroke

doi:10.19854/j.cnki.1008-2425.2024.02.0007

Abstract

Abstract: Objective To observe the effectiveness and safety of intravenous thrombolysis with rt-PA in patients of acute mild ischemic stroke. Methods Retrospective analyze a total of 107 acute ischemic stroke patients with baseline NIHSS≤3 were enrolled in the study who hospitalized in Shanghai Jiading District Central Hospital from January 2021 to December 2021.Acco rding to whether performing intravenous thrombolysis or not, 107 patients were divided into intravenous thrombolysis group(n=49) and non-venous thrombolysis group(n=58).The baseline and clinical data were recorded for both groups and their differences were compared.The scores and the rates of reduction of NIHSS in 24 h, 7d and 14 d after treatment of the two groups were analyzed, also the scores of 7dmRs and 90dmRS.The incidence of extracranial /intracranial hemorrhage, the rate of death was also compared between the two groups. Results There were no significant differences in baseline data and 24 hNIHSS score.NIHSS in 7 d and 14d after treatment were lower in intravenous thrombolysis group, p was 0.020 and 0.008 respectively.The rate of reduction of NIHSS in 24 h, 7d and 14 d were higher in intravenous thrombolysis group, all the three p were 0.000.The scores of 7 d and 90dmRS were lower in intravenous thrombolysis group, but only 7dmRS score between the two groups was statistically significant, P=0.014, while 90dmRS score between the two groups was not statistically significant, P=0.153.Both at 7 d and 90 d, the proportions of good prognosis(mRS score 0-2)inintravenous thrombolysis group were higher, but there was no differencebetween the two groups , neither at 7 d nor at 90 d after treatment, p were 0.109 and 0.358 respectively.The incidences of extracranial hemorrhage and intracranial hemorrhagewere higher in intravenous thrombolysis group, p was 0.000 and 0.018 respectively.But no symptomatic intracranial hemorrhageand death occurred in both groups. Conclusion Thrombolysis with rt-PA inmildacuteischemicstroke(NIHSS≤3) can improve early neurological deficits, increase the incidence of mild extracranial /intracranial hemorrhage, but with no serious adverse outcome.

Key words: MildIschemicStroke, Intravenousthrombolysis, Recombinant tissue plasminogen activator

摘要： 目的观察重组组织型纤溶酶原激活剂(rt-PA)治疗急性轻型缺血性脑卒中的疗效和安全性。方法回顾性分析2021年1月~2021年12月在上海市嘉区中心医院神经内科病房住院的发病≤4.5 h,基线NIHSS≤3分的急性轻型缺血性脑卒中患者107例,按是否静脉溶栓治疗分为静脉溶栓组49例,非静脉溶栓组58例。比较两组基线资料,并比较两组治疗后24 h、7 d、14 dNIHSS评分分值及其评分下降率判断疗效,7 d、90 d改良Rankin'S量表(mRS)评分判断预后,同时比较两组间颅内外出血及死亡发生率判断安全性。结果两组在基线临床资料及24hNIHSS 评分上结果无显著差异,静脉溶栓组7dNHISS评分及14 dNHISS评分均低于非静脉溶栓组,P值分别为0.020和0.008。静脉溶栓组在24 h、7 d及14 dNIHSS评分与基线NIHSS评分相比,其NIHSS评分下降率均显著高与非静脉溶栓组,P值均为0.000。静脉溶栓组在7 dmRs和90 dmRS评分上数据均低于非静脉溶栓组,但仅有7 dmRs评分两组对比统计有显著差异,P=0.014,90 dmRs评分上两组数据对比结果无统计学意义,P=0.153。7 d和90 d评估mRs预后良好(mRS评分0~2分)比例方面,静脉溶栓组预后良好的比例高于非静脉溶栓组,但两组对比结果无显著差异,P值分别是0.109和 0.358。安全性方面,静脉溶栓组颅外及颅内出血比例均高于非静脉溶栓组,P值分别为0.000和0.018,但两组均未发生症状性颅内出血或死亡。结论对NIHSS≤3分急性轻型缺血性脑卒中患者进行rt-PA静脉溶栓可以改善急性期神经功能缺损,颅内外出血风险有所增加,但无严重不良结局。

关键词: 轻型缺血性脑卒中, 静脉溶栓, 重组组织型纤溶酶原激活剂

CLC Number:

R743.31

Yao Meifen, Ding Gangyu, Xu Jianhua, Wang Guojiang. Efficacy ofintravenousthrombolysiswithrt-PAinpeoplewithAcuteMildIschemicStroke[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(2): 101-106.

姚美芬, 丁刚玉, 徐建华, 王国江. 急性轻型缺血性脑卒中rt-PA静脉溶栓治疗的疗效分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(2): 101-106.

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