中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2012年
10期
1030-1033
,共4页
林念童%杨碧萍%冼树清%潘速跃
林唸童%楊碧萍%冼樹清%潘速躍
림념동%양벽평%승수청%반속약
急性缺血性脑卒中%动脉溶栓%静脉溶栓%阿替普酶%比较性研究
急性缺血性腦卒中%動脈溶栓%靜脈溶栓%阿替普酶%比較性研究
급성결혈성뇌졸중%동맥용전%정맥용전%아체보매%비교성연구
Acute ischemic stroke%Intra-arterial thrombolysis%Thrombolytic therapy%Tissue plasminogen activator%Comparative study
目的 比较阿替普酶溶栓治疗急性缺血性脑卒中时静脉溶栓和动脉溶栓的有效性和安全性的差异. 方法 回顾性分析广州医学院第一附属医院自2005年初至2010年底连续登记在库的急性缺血性脑卒中患者的临床资料,包括患者入院时人口学特征、溶栓时间窗、院内时间延误、溶栓途径、阿替普酶剂量、脑卒中严重程度、各项生化和凝血指标及溶栓前重要生命体征,以及CT表现和脑卒中TOAST分型,评价溶栓后出血性转化、血管再通分级和溶栓后90 d预后及死亡率.采用变量筛选技术挑选影响预后的可能因素,并用二元Logistic回归模型分析独立影响因素.结果 本研究共入选96例患者,1例失访,其中男性43例(44.8％),女性53例(55.2％)；年龄中位数72岁,体质量中位数58.5 kg;溶栓时间窗中位数4.3 h；静脉溶栓64例,动脉溶栓32例；溶栓后90 d预后良好率为43.8％,死亡率为17.9％.单因素分析显示,动脉溶栓组较静脉溶栓组男性患者比例较高(71.9％vs 31.3％),总费用明显偏高(47623.6元vs 25699.8元),院内延误时间(3.17 hvs 1.73 h)和溶栓时间窗(5.54 h vs 3.58 h)明显延长,阿替普酶用量明显偏少(20 mg vs 50 mg),差异均有统计学意义(P＜0.05)；2组溶栓后36h内责任血管再通率(64.9％vs 53.8％)、出血转化率(25％vs 31.3％)、90 d预后良好比例(45.3％ vs 40.6％)和死亡率(14.7％vs 3.2％)比较差异均无统计学意义(P＞0.05).多因素Logistic回归显示溶栓方式对预后无显著影响(OR=0.54,P=0.824,95％ CI:0.00-131.46);血管再通良好是预后良好独立保护因素(OR=0.11,P=0.027,95％ CI:0.02-0.78),但不同溶栓方式对血管再通无显著影响. 结论 在急性缺血性脑卒中的溶栓治疗中,阿替普酶动脉溶栓和静脉溶栓后90 d预后良好比例相当,溶栓后出血转化率和死亡率无明显差异,不同溶栓方式对临床结局无影响.
目的 比較阿替普酶溶栓治療急性缺血性腦卒中時靜脈溶栓和動脈溶栓的有效性和安全性的差異. 方法 迴顧性分析廣州醫學院第一附屬醫院自2005年初至2010年底連續登記在庫的急性缺血性腦卒中患者的臨床資料,包括患者入院時人口學特徵、溶栓時間窗、院內時間延誤、溶栓途徑、阿替普酶劑量、腦卒中嚴重程度、各項生化和凝血指標及溶栓前重要生命體徵,以及CT錶現和腦卒中TOAST分型,評價溶栓後齣血性轉化、血管再通分級和溶栓後90 d預後及死亡率.採用變量篩選技術挑選影響預後的可能因素,併用二元Logistic迴歸模型分析獨立影響因素.結果 本研究共入選96例患者,1例失訪,其中男性43例(44.8％),女性53例(55.2％)；年齡中位數72歲,體質量中位數58.5 kg;溶栓時間窗中位數4.3 h；靜脈溶栓64例,動脈溶栓32例；溶栓後90 d預後良好率為43.8％,死亡率為17.9％.單因素分析顯示,動脈溶栓組較靜脈溶栓組男性患者比例較高(71.9％vs 31.3％),總費用明顯偏高(47623.6元vs 25699.8元),院內延誤時間(3.17 hvs 1.73 h)和溶栓時間窗(5.54 h vs 3.58 h)明顯延長,阿替普酶用量明顯偏少(20 mg vs 50 mg),差異均有統計學意義(P＜0.05)；2組溶栓後36h內責任血管再通率(64.9％vs 53.8％)、齣血轉化率(25％vs 31.3％)、90 d預後良好比例(45.3％ vs 40.6％)和死亡率(14.7％vs 3.2％)比較差異均無統計學意義(P＞0.05).多因素Logistic迴歸顯示溶栓方式對預後無顯著影響(OR=0.54,P=0.824,95％ CI:0.00-131.46);血管再通良好是預後良好獨立保護因素(OR=0.11,P=0.027,95％ CI:0.02-0.78),但不同溶栓方式對血管再通無顯著影響. 結論 在急性缺血性腦卒中的溶栓治療中,阿替普酶動脈溶栓和靜脈溶栓後90 d預後良好比例相噹,溶栓後齣血轉化率和死亡率無明顯差異,不同溶栓方式對臨床結跼無影響.
목적 비교아체보매용전치료급성결혈성뇌졸중시정맥용전화동맥용전적유효성화안전성적차이. 방법 회고성분석엄주의학원제일부속의원자2005년초지2010년저련속등기재고적급성결혈성뇌졸중환자적림상자료,포괄환자입원시인구학특정、용전시간창、원내시간연오、용전도경、아체보매제량、뇌졸중엄중정도、각항생화화응혈지표급용전전중요생명체정,이급CT표현화뇌졸중TOAST분형,평개용전후출혈성전화、혈관재통분급화용전후90 d예후급사망솔.채용변량사선기술도선영향예후적가능인소,병용이원Logistic회귀모형분석독립영향인소.결과 본연구공입선96례환자,1례실방,기중남성43례(44.8％),녀성53례(55.2％)；년령중위수72세,체질량중위수58.5 kg;용전시간창중위수4.3 h；정맥용전64례,동맥용전32례；용전후90 d예후량호솔위43.8％,사망솔위17.9％.단인소분석현시,동맥용전조교정맥용전조남성환자비례교고(71.9％vs 31.3％),총비용명현편고(47623.6원vs 25699.8원),원내연오시간(3.17 hvs 1.73 h)화용전시간창(5.54 h vs 3.58 h)명현연장,아체보매용량명현편소(20 mg vs 50 mg),차이균유통계학의의(P＜0.05)；2조용전후36h내책임혈관재통솔(64.9％vs 53.8％)、출혈전화솔(25％vs 31.3％)、90 d예후량호비례(45.3％ vs 40.6％)화사망솔(14.7％vs 3.2％)비교차이균무통계학의의(P＞0.05).다인소Logistic회귀현시용전방식대예후무현저영향(OR=0.54,P=0.824,95％ CI:0.00-131.46);혈관재통량호시예후량호독립보호인소(OR=0.11,P=0.027,95％ CI:0.02-0.78),단불동용전방식대혈관재통무현저영향. 결론 재급성결혈성뇌졸중적용전치료중,아체보매동맥용전화정맥용전후90 d예후량호비례상당,용전후출혈전화솔화사망솔무명현차이,불동용전방식대림상결국무영향.
Objective To compare the efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator in Chinese patients with acute ischemic stroke.Methods Patients with acute ischemic stroke,consecutively registered in our database from 2005 to 2010,were included.Admission demographics,time window,procedure delay in hospital,route of thrombolysis,dose of tissue plasminogen activator,stroke severity,laboratory tests and vital signs of these patients were collected.CT manifestations and TOAST subtypes were obsevred.Outcome variables included hemorrhagic transformation,re-canalization of responsible vessels,favorable functional outcome 90 d after thrombolysis and mortality were evaluated.Univariate and multivariate logistic regression were used to select the potential variables and compare the differences between the two kinds of route in thrombolysis.Results A total of 96 patients were included with one loss of follow-up.Forty-three were male (44.8％) and 53 female.Median age was 72 years,median body weight 58.5 kilograms,and median time window 4.3 hours.Sixty-four patients received intravenous thrombolysis and 32 patients intra-arterial thrombolysis.Favorable outcome was achieved in 43.8％ patients 90 d after thrombolysis with a mortality reaching 17.9％.Univariate analysis showed intra-arterial thrombolysis had a much higher cost (47623.6 vs 25699.8 RMB),longer procedure delay (3.17 h vs 1.73 hours) and time window (5.54 vs 3.58 hours),and lower dose (20 vs 50 mg) as compared with intravenous thrombolysis (P＜0.05);however,no significant differences were found between the 2 groups in re-canalization of responsible vessels (64.9％ vs 53.8％),hemorrhagic transformation (25％ vs 31.3％),favorable outcome (45.3％ vs 40.6％) and mortality (14.7％ vs 3.2％).Multivariate logistic regression indicated that route of thrombolysis did not predict unfavorable outcome (OR=0.54,P=0.824,95％ CI:0.00-131.46);re-canalization could independently predict the functional outcome (OR=0.11,P=0.027,95％ CI:0.02-0.78),while the route of thrombolysis itself did not influence the re-canalization.Conclusion In patients with acute ischemic stroke,the treatment efficacy and safety of intravenous and intra-arterial thrombolysis with tissue plasminogen activator are similar,not enjoying significant difference in hemorrhagic transformation and mortality.
