阿替普酶静脉溶栓治疗轻型缺血性卒中的临床研究

王玉才 王会 张梅

[摘要] 目的 探討阿替普酶静脉溶栓治疗轻型缺血性卒中患者的安全性和90 d预后。 方法 选择2015年10月～2018年9月在北京市顺义区医院神经内科收治的110例轻型急性缺血性卒中患者，根据是否行阿替普酶静脉溶栓治疗分为溶栓组和非溶栓组，其中溶栓组42例，非溶栓组68例。比较两组溶栓后24 h美国国立卫生研究院卒中量表评分（NIHSS）、90 d改良Rankin评分及出血转化发生率。 结果 非溶栓组基线NIHSS评分为（1.86±0.55）分，溶栓组基线NIHSS评分为（1.94±0.58）分，差异无统计学意义（P>0.05）。非溶栓组24 h NIHSS评分为（1.69±0.32）分，溶栓组24 h NIHSS评分为（0.95±0.23）分。与非溶栓组患者相比，溶栓组患者24 h NIHSS评分更低，差异有统计学意义（P<0.05）。溶栓组中，与溶栓前NIHSS评分比较，溶栓后24 h NIHSS评分更低，差异有统计学意义（P<0.05）。溶栓组发生出血转化为2例（4.8%），非溶栓组发生出血转化为3例（4.4%），差异无统计学意义（P>0.05）。两组患者均未出现脑实质出血。溶栓组预后良好（mRS≤1分）的患者为38例（90.5%），预后不良（2≤mRS≤6分）的患者为4例（9.5%）;非溶栓组预后良好的患者为51例（75.0%），预后不良患者为17例（25.0%），差异有统计学意义（P<0.05）。 结论 轻型急性缺血性卒中患者在发病4.5h内进行阿替普酶静脉溶栓有助于降低24 h NIHSS评分，改善90 d预后，并不增加出血转化。

[关键词] 轻型缺血性卒中;阿替普酶;溶栓

[中图分类号] R743.3          [文献标识码] B          [文章编号] 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.