[1]吴小杨 黄艮彬 林齐防 谢雯熙.轻型急性缺血性脑卒中患者静脉溶栓治疗的疗效分析[J].卒中与神经疾病杂志,2019,26(03):271-276.[doi:10.3969/j.issn.1007-0478.2019.03.004]
　Wu Xiaoyang,Huang Genbin,Lin Qifang,et al.The efficacy of recombinant tissue plasminogen activator(rt-PA)in the treatment of mild acute ischemic stroke patients[J].Stroke and Nervous Diseases,2019,26(03):271-276.[doi:10.3969/j.issn.1007-0478.2019.03.004]
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轻型急性缺血性脑卒中患者静脉溶栓治疗的疗效分析()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第26卷
期数:
2019年03期
页码:
271-276
栏目:
论 著
出版日期:
2019-06-25

文章信息/Info

Title:
The efficacy of recombinant tissue plasminogen activator(rt-PA)in the treatment of mild acute ischemic stroke patients
文章编号:
1007-0478(2019)03-0271-06
作者:
吴小杨 黄艮彬 林齐防 谢雯熙
352100 福建省宁德市福建医科大学附属宁德市医院神经内科(吴小杨 黄艮彬 林齐防),药剂科[谢雯熙(通信作者)]
Author(s):
Wu Xiaoyang;  Huang Genbin;  Lin Qifang;  et al
Department of Neurology, Ningde Hospital Affiliated to Fujian Medical University, Ningde Fujian 352100
关键词:
轻型急性缺血性脑卒中 重组组织型纤溶酶原激活剂 静脉溶栓 NIHSS评分 mRS评分
Keywords:
Mild acute ischemic stroke rt-PA Intravenous thrombolysis NIHSS score mRS score
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2019.03.004
文献标志码:
A
摘要:
目的 探讨重组组织型纤溶酶原激活剂(rt-PA)治疗轻型急性缺血性脑卒中患者的疗效。方法 收集100例发病<4.5 h的轻型急性缺血性脑卒患者,随机分为溶栓组50例,未溶栓组50例; 溶栓组于入院后给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,24 h后非心源性脑栓塞患者给予阿司匹林+氯吡格雷双联抗血小板聚集治疗,21d后改阿司匹林或氯吡格雷治疗,心源性脑栓塞患者给予抗凝治疗; 未溶栓组非心源性脑栓塞患者给予阿司匹林+氯吡格雷双联抗血小板聚集治疗,21d后改阿司匹林或氯吡格雷治疗,心源性脑栓塞患者给予抗凝治疗; 对所有患者入院时及治疗后第14 d、90 d分别进行NIHSS神经功能缺损评分及第90 d mRS评分,比较2组患者的疗效和预后。结果 入院时溶栓组及未溶栓组患者一般临床资料、NIHSS评分及mRS评分等比较无明显差异(P>0.05); 治疗后第14、90 d与未溶栓组患者比较,溶栓组患者的NIHSS评分及mRS评分显著降低,溶栓组患者的预后明显好于未溶栓组(P<0.05); 2组患者的颅内出血发生率、缺血性脑卒中复发率比较无明显差异(P均>0.05),且2组患者均无死亡。结论 rt-PA静脉溶栓治疗轻型急性缺血性脑卒中患者安全有效。
Abstract:
ObjectiveTo investigate the efficacy of recombinant tissue plasminogen activator(rt-PA)in the treatment of mild acute ischemic stroke patients.Methods 100 patients with mild acute ischemic stroke less than 4.5 hours after onset were randomly divided into thrombolytic group(50 cases)and non-thrombolytic group(50 cases).The thrombolytic group received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)after admission,24 hours later patients with non-cardiogenic embolism were treated with aspirin plus clopidogrel, 21 days later with aspirin or clopidogrel, and patients with cardiogenic embolism were treated with anticoagulation. Non-cardiogenic embolism patients in the non-thrombolytic group were treated with aspirin plus clopidogrel dual antiplatelet therapy, and 21 days later were treated with aspirin or clopidogrel, and patients with cardiogenic embolism were treated with anticoagulation therapy. All patients were assessed by NIHSS neurological deficit score and mRS score at admission and 14 and 90 days after treatment respectively. The therapeutic efficacy and prognosis of the two groups were compared.Results There were no significant differences in general clinical data, NIHSS score and mRS score between thrombolytic group and non-thrombolytic group at admission(P>0.05).The NIHSS score and mRS score of thrombolytic group were significantly lower than those of non-thrombolytic group at 14 and 90 days after treatment. The prognosis of thrombolytic group was significantly better than that of non-thrombolytic group(P<0.05). There were no significant differences in the incidence rate of intracranial hemorrhage and the recurrence rate of ischemic stroke between the two groups(P>0.05). No death occurred in the two groups.Conclusion Rt-PA intravenous thrombolysis was safe and effective in the treatment of mild acute ischemic stroke.

参考文献/References:

[1] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华医学信息导报,2010,25(14):16-19.
[2] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246-257.
[3] 李菁晶,鞠奕,潘岳松,等.轻型缺血性脑卒中患者急性期神经功能恶化的相关因素分析[J].中华老年心脑血管病杂志,2016,18(7):715-718.
[4] Weimar C, Benemann J, Michalski D, et al. Prediction of recurrent stroke and vascular death in patients with transient ischemic attack or nondisabling stroke:a prospective comparison of validated prognostic scores[J]. Stroke; a Journal of Cerebral Circulation, 2010, 41(3):487-493.
[5] Wu Ling-yun, Wang An-xin, Wang Xian-wei, et al. Factors for short-term outcomes in patients with a minor stroke:results from China National Stroke Registry[J]. BMC Neurology, 2015, 15(1):253.
[6] 国家卫生计生委脑卒中防治工程委员会.中国急性缺血性脑卒中静脉溶栓指导规范(2016年).国家卫生计生委脑卒中防治工程委员会,2015.
[7] 国家卫生计生委脑卒中筛查与防治工程委员会.脑卒中筛查与防治技术规范[J].中国医学前沿杂志:电子版,2013,5(9):44-50.
[8] Wang Wen-zhi, Jiang Bin, Sun Hai-xin, et al. Prevalence, incidence, and mortality of stroke in China results from a nationwide Population-Based survey of 480 687 adults[J]. Circulation, 2017, 135(8):759.
[9] Wang D, Liu J, Liu M, et al. Patterns of stroke between university hospitals and non-university hospitals in mainland China:a prospective multicenter hospital-based registry study[J].World Neurosurgery,2017, 98(2):258-265.
[10] Chan M, Westergaard M, Mayhook A, et al. Abstract TP140:Recurrence and outcomes in patients who experience a mild ischemic stroke:A systematic review[J].Stroke,2016,47(2):ATP140
[11] Smith EE, Fonarow GC, Reeves MJ, et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant Tissue-Type plasminogen activator[J]. Stroke; a Journal of Cerebral Circulation, 2011, 42(11):3110-3115.
[12] Gadodia G, Rizk N, Camo D, et al. Presenting symptoms and dysphagia screen predict outcome in mild and rapidly improving acute ischemic stroke patients[J]. Journal of Stroke & Cerebrovascular Diseases, 2016, 25(12):2876-2881.
[13] Romano JG, SmithEE, Liang L, et al. Distinct Short-Term outcomes in patients with mild versus rapidly improving stroke not treated with thrombolytics[J]. Stroke, 2016, 47(5):1278-1285.
[14] Khatri P, Conaway MR, Johnston KC, et al. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke[J]. Stroke; a Journal of Cerebral Circulation, 2012, 43(2):560-562.
[15] NedeltchevK, SchweglerB, HaefeliT, et al. Outcome of stroke with mild or rapidly improving symptoms[J]. Stroke, 2007, 38(9):2531-2535.
[16] Camp D, Bryant K, Zimmermann S, et al. Abstract NS7:Presenting symptoms and response to dysphagia screen predict unfavorable outcome in acute ischemic stroke patients who do not receive IV tPA due to mild and rapidly improving stroke symptoms[J].Stroke,2015,46(2):ANS7.
[17] Urra X, Ariño H, Liull L, et al. The outcome of patients with mild stroke improves after treatment with systemic thrombolysis[J]. PLOS One, 2013, 8(3):e59420.
[18] Urra X,Ariño H,Amaro S,et al. Abstract TP59:Clinical course and radiological outcome of mild stroke patients treated and not treated with thrombolysis[J].Stroke,2013,44(2):ATP59.
[19] Carnahan B, Corless L, Lucas L, et al. Abstract TP73:Better functional outcomes in patients treated versus not treated for mild stroke[J].Stroke,2018,49(1):73.
[20] Chen Wei-qi, Pan Yu-esong, Zhao Xing-quan, et al. Intravenous thrombolysis in Chinese patients with different subtype of mild stroke:thrombolysis in patients with mild stroke[J]. Scientific Reports, 2017, 7(1):2299.
[21] Köhrmann M, Nowe T, Huttner HB, et al. Safety and outcome after thrombolysis in stroke patients with mild symptoms[J]. Cerebrovascular Diseases(Basel, Switzerland), 2009, 27(2):160-166.
[22] Hassan AE, Zacharatos H, Hassanzadeh B, et al. Does mild deficit for patients with stroke justify the use of intravenous tissue plasminogen activator?[J]. Journal of Stroke and Cerebrovascular Diseases:the Official Journal of National Stroke Association, 2010, 19(2):116-120.
[23] Khatri P, Khoury JC, Alwell K, et al. The public health impact of an effective acute treatment for mild ischemic strokes[J]. Stroke, 2011, 42(3):E66.
[24] Romano JG, Smith EE, Liang Li, et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis a retrospective analysis of the get with the Guidelines-Stroke registry[J]. JAMA Neurology, 2015, 72(4):423-431.
[25] Huang Q, Ma Q, Jia J, et al. Intravenous thrombolysis for minor stroke and rapidly improving symptoms:aquantitative overview[J]. Neurological Sciences, 2014, 35(9):1321-1328.
[26] Spokoyny I, Raman R, Ernstrom K, et al. Defining mild stroke:outcomes analysis of treated and untreated mild stroke patients[J]. Journal of Stroke & Cerebrovascular Diseases, 2015, 24(6):1276-1281.
[27] Shi Lei, Zhang Min, Liu Hengfang, et al. Safety and outcome of thrombolysis in mild stroke:a meta-analysis[J]. Medical Science Monitor:International Medical Journal of Experimental and Clinical Research, 2014, 20(11):2117-2124.
[28] Willey JZ, Khatri P, Khoury JC, et al. Variability in the use of intravenous thrombolysis for mild stroke:experience across the SPOTRIAS network[J]. Journal of Stroke & Cerebrovascular Diseases, 2013, 22(4):318-322.

备注/Memo

备注/Memo:
基金项目:宁德市科学技术计划项目(20160090)
更新日期/Last Update: 2019-06-25