浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
18期
1527-1530
,共4页
杨雯%张征%王贞%冯靓%殷为勇%朱振国%程建华%王新施%朱碧宏%王志敏%韩钊
楊雯%張徵%王貞%馮靚%慇為勇%硃振國%程建華%王新施%硃碧宏%王誌敏%韓釗
양문%장정%왕정%풍정%은위용%주진국%정건화%왕신시%주벽굉%왕지민%한쇠
脑梗死%溶栓%组织型纤溶酶原激活剂%脑出血
腦梗死%溶栓%組織型纖溶酶原激活劑%腦齣血
뇌경사%용전%조직형섬용매원격활제%뇌출혈
Cerebral infarction%Thrombolysis%Tissue plasminogen activator%Cerebral hemorrhage
目的:分析重组组织型纤溶酶原激活剂(rt- PA)静脉溶栓治疗急性脑梗死患者的有效性和安全性。方法128例在发病9.0h内接受rt- PA静脉溶栓治疗的急性脑梗死患者,按发病到治疗的时间(OTT)分为A组(0~3.0h)、B组(3.0~4.5h)、C组(4.5~6.0h)、D组(6.0~9.0h)4组,其中OTT>4.5h的共25例,均采用多模式CT筛选。有效性指标采用发病后3个月时的改良Rank评分(mRS),0~1分定义为预后良好,安全性指标采用患者发病后36.0h内症状性脑出血的发生率和3个月内病死率。结果128例患者总体预后良好率为37.5%(48/128),A~D组预后良好率分别为45.4%(20/44)、39.0%(23/59)、28.6%(4/14)、9.1%(1/11),4组间比较无统计学差异(字2=6.371,P>0.05)。症状性脑出血总发生率7.8%(10/128),A~D组分别为9.1%(4/44)、10.2%(6/59)、0.0%(0/14)、0.0%(0/11),4组间比较无统计学差异(χ2=1.546,P>0.05)。患者3个月内总体病死率14.1%(18/128),A~D组分别为13.6%(6/44)、13.6%(8/59)、14.3%(2/14)、18.2%(2/11),4组间比较无统计学差异(字2=0.102,P>0.05)。结论发病3.0h内使用rt- PA溶栓有效性最好,OTT延长则有效性降低。溶栓增加症状性脑出血发生率,多模式CT筛选可能有助于减少症状性脑出血发生率。
目的:分析重組組織型纖溶酶原激活劑(rt- PA)靜脈溶栓治療急性腦梗死患者的有效性和安全性。方法128例在髮病9.0h內接受rt- PA靜脈溶栓治療的急性腦梗死患者,按髮病到治療的時間(OTT)分為A組(0~3.0h)、B組(3.0~4.5h)、C組(4.5~6.0h)、D組(6.0~9.0h)4組,其中OTT>4.5h的共25例,均採用多模式CT篩選。有效性指標採用髮病後3箇月時的改良Rank評分(mRS),0~1分定義為預後良好,安全性指標採用患者髮病後36.0h內癥狀性腦齣血的髮生率和3箇月內病死率。結果128例患者總體預後良好率為37.5%(48/128),A~D組預後良好率分彆為45.4%(20/44)、39.0%(23/59)、28.6%(4/14)、9.1%(1/11),4組間比較無統計學差異(字2=6.371,P>0.05)。癥狀性腦齣血總髮生率7.8%(10/128),A~D組分彆為9.1%(4/44)、10.2%(6/59)、0.0%(0/14)、0.0%(0/11),4組間比較無統計學差異(χ2=1.546,P>0.05)。患者3箇月內總體病死率14.1%(18/128),A~D組分彆為13.6%(6/44)、13.6%(8/59)、14.3%(2/14)、18.2%(2/11),4組間比較無統計學差異(字2=0.102,P>0.05)。結論髮病3.0h內使用rt- PA溶栓有效性最好,OTT延長則有效性降低。溶栓增加癥狀性腦齣血髮生率,多模式CT篩選可能有助于減少癥狀性腦齣血髮生率。
목적:분석중조조직형섬용매원격활제(rt- PA)정맥용전치료급성뇌경사환자적유효성화안전성。방법128례재발병9.0h내접수rt- PA정맥용전치료적급성뇌경사환자,안발병도치료적시간(OTT)분위A조(0~3.0h)、B조(3.0~4.5h)、C조(4.5~6.0h)、D조(6.0~9.0h)4조,기중OTT>4.5h적공25례,균채용다모식CT사선。유효성지표채용발병후3개월시적개량Rank평분(mRS),0~1분정의위예후량호,안전성지표채용환자발병후36.0h내증상성뇌출혈적발생솔화3개월내병사솔。결과128례환자총체예후량호솔위37.5%(48/128),A~D조예후량호솔분별위45.4%(20/44)、39.0%(23/59)、28.6%(4/14)、9.1%(1/11),4조간비교무통계학차이(자2=6.371,P>0.05)。증상성뇌출혈총발생솔7.8%(10/128),A~D조분별위9.1%(4/44)、10.2%(6/59)、0.0%(0/14)、0.0%(0/11),4조간비교무통계학차이(χ2=1.546,P>0.05)。환자3개월내총체병사솔14.1%(18/128),A~D조분별위13.6%(6/44)、13.6%(8/59)、14.3%(2/14)、18.2%(2/11),4조간비교무통계학차이(자2=0.102,P>0.05)。결론발병3.0h내사용rt- PA용전유효성최호,OTT연장칙유효성강저。용전증가증상성뇌출혈발생솔,다모식CT사선가능유조우감소증상성뇌출혈발생솔。
Objective To assess the efficacy and safety of thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt- PA) for patients with acute cerebral infarction. Methods One hundred twenty eight patients with acute cerebral infarction received intravenous rt- PA thrombolytic therapy within 9h after onset; rt- PA therapy started 0~3.0, 3.0~4.5, 4.5~6.0 and 6.0~9.0h after onset of stroke in 44, 59, 14 and 11 cases, respectively. The efficacy was evaluated with modified Rankin Scale (mRS)at the 3rd month after onset of stroke;the symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months after onset of stroke were documented. Results The overall rate of good prognosis at the 3rd month was 37.5%(48/128), and that for 0~3.0 h, 3.0~4.5 h, 4.5~6.0 h and 6.0~9.0 h groups was 45.4% (20/44), 39.0% (23/59), 28.6% (4/14) and 9.1%(1/11) respectively(χ2=6.371, P>0.05).The overal incidence of symptomatic cerebral hemorrhage was 7.8%(10/128);that for 0~3.0 h, 3.0~4.5 h, 4.5~6.0 h and 6.0~9.0 h groups was 9.1%(4/44), 10.2%(6/59), 0.0%(0/14) and 0.0%(0/11) respectively. The overal mortality during 3 month after onset of stroke was 14.1%(18/128);that for 0~3.0h, 3.0~4.5h, 4.5~6.0h and 6.0~9.0h groups was 13.6%(6/44), 13.6%(8/59), 14.3%(2/14) and18.2%(2/11) respectively. Conclusion The efficacy of thrombolytic ther-apy within 3h after the onset of stroke is the best, delayed thrombolytic therapy may affect the efficacy. Thrombolytic therapy in-creases the incidence of symptomatic intracerebral hemorrhage. Multi- modal CT screening can help reduce the symptoms of cerebral hemorrhage.