CAJ | 학술논문

目的：探讨重组组织型纤溶酶（ rt-PA）静脉溶栓治疗急性缺血性脑卒中的临床疗效。方法将急性缺血性脑卒中（症状出现＜4．5 h）患者76例按信封法随机分为两组，每组38例。溶栓组给予rt-PA 0.9 mg/kg，最大用量90 mg；其中总剂量的10％采用静脉推注，推注时间＞1 min，其余90％的剂量要求在1 h内静脉滴注。溶栓后头24 h，不得使用抗凝药或阿斯匹林。之后如临床和头颅CT复查显示无出血，可行抗血小板和/或抗凝治疗。对照组应用阿司匹林口服，灯盏花素注射液及胞磷胆碱静滴治疗，疗程14 d。所有病例均应用甘露醇，对有并发症的患者予以对症治疗。然后观测入院时及治疗后第1、7、21天NIHSS评分。结果溶栓组第1、7、21天NIHSS评分明显降低，各是（11．3±3．6）分，（9．1±2．8）分，（8．3±3．9）分。神经功能缺损程度及日常生活活动能力显著提高（P＜0．05），各是93．3％，93．3％，96．7％。不良事件发生率及病死率各是6．7％，6．7％，3．3％，差异无统计学意义（P＞0．05）。结论 rt-PA静脉溶栓治疗急性缺血性脑卒中效果显著，能明显缩短病程，降低致残率，提高患者的生活质量。
목적：탐토중조조직형섬용매（ rt-PA）정맥용전치료급성결혈성뇌졸중적림상료효。방법장급성결혈성뇌졸중（증상출현＜4．5 h）환자76례안신봉법수궤분위량조，매조38례。용전조급여rt-PA 0.9 mg/kg，최대용량90 mg；기중총제량적10％채용정맥추주，추주시간＞1 min，기여90％적제량요구재1 h내정맥적주。용전후두24 h，불득사용항응약혹아사필림。지후여림상화두로CT복사현시무출혈，가행항혈소판화/혹항응치료。대조조응용아사필림구복，등잔화소주사액급포린담감정적치료，료정14 d。소유병례균응용감로순，대유병발증적환자여이대증치료。연후관측입원시급치료후제1、7、21천NIHSS평분。결과용전조제1、7、21천NIHSS평분명현강저，각시（11．3±3．6）분，（9．1±2．8）분，（8．3±3．9）분。신경공능결손정도급일상생활활동능력현저제고（P＜0．05），각시93．3％，93．3％，96．7％。불량사건발생솔급병사솔각시6．7％，6．7％，3．3％，차이무통계학의의（P＞0．05）。결론 rt-PA정맥용전치료급성결혈성뇌졸중효과현저，능명현축단병정，강저치잔솔，제고환자적생활질량。
Objective To explore the recombinant tissue type fibrinolytic enzyme ( rt-PA) intravenous throm-bolysis treatment the clinical curative effect of acute ischemic stroke .Methods Will appear symptoms of acute ische-mic stroke(<4.5 hours)patients,76 cases were randomly divided into the two groups according to the envelope meth -od,38 cases in each group .Thrombolysis group was given rt-PA 0.9mg/kg,maximum dose of 90mg;10%of the total dose intravenous injection ,pushing injection time>1 minute,the remaining 90%of the dose required intravenous drip within 1h.Thrombolysis in 24 hours,not the use of anticoagulants or aspirin .After such as clinical and head CT shows no bleeding,review of the available antiplatelet and/or anticoagulant therapy.Control group used aspirin oral,lamps take injection and static drop treatment ,cytidine diphosphate choline course of 14 days.All cases of application of mannitol,symptomatic treatment for patients with complications .Then observation on admission and treatment 1,7,21 days after the NIHSS score .Results Thrombolysis group 1,7,21 days NIHSS score significantly reduced ,each was (11.3 ±3.6)points,(9.1 ±2.8)points,(8.3 ±3.9)points,Degree of neurologic deficits and daily life activities a-bility increased significantly(P<0.05)were 93.3%,93.3%and 93.3%,There was no statistically significant differ-ence incidence and case fatality rate of adverse events (P>0.05),each was 6.7%,6.7%,3.3%.Conclusion Rt-PA intravenous thrombolysis for acute ischemic stroke effect significantly ,can significantly shorten the course of the disease,reduce morbidity,improve the quality of life of the patients .