中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
12期
1314-1318
,共5页
郭舜源%陈波%史宗杰%陈珂楠%耿昱
郭舜源%陳波%史宗傑%陳珂楠%耿昱
곽순원%진파%사종걸%진가남%경욱
急性脑梗死%重组组织型纤溶酶原激活物%心房颤动%注射,静脉内%血栓溶解疗法%脑出血%预后%神经功能
急性腦梗死%重組組織型纖溶酶原激活物%心房顫動%註射,靜脈內%血栓溶解療法%腦齣血%預後%神經功能
급성뇌경사%중조조직형섬용매원격활물%심방전동%주사,정맥내%혈전용해요법%뇌출혈%예후%신경공능
Acute ischemic stroke%Recombinant tissue plasminogen activator%Atrial fibrillation%Injections%intravenous%Thrombolytic therapy%Cerebral hemorrhage%Neurological function%Prognosis
目的 观察伴心房颤动的急性脑梗死患者使用重组组织型纤溶酶原激活物(rt-PA)静脉溶栓的疗效.方法 连续收集发病时间＜4.5h的94例应用rt-PA静脉溶栓治疗的急性脑梗死患者,将64例无心房颤动患者作为非心房颤动组,30例伴心房颤动患者作为心房颤动组,并收集同一时段30例未行溶栓治疗的伴有心房颤动的急性脑梗死患者作为对照组,比较3组患者治疗前及治疗后7d的美国国立卫生研究院卒中量表(NIHSS)评分,观察颅内出血(ICH)和症状性颅内出血(SICH)的发生率,采用改良Rankin量表(mRS)对3组患者3个月预后进行分析.结果 心房颤动组和非心房颤动组溶栓后7d的NIHSS评分较溶栓前显著降低(P＜0.05或P＜0.01);对照组治疗前后NIHSS评分比较差异无统计学意义(P＞0.05);心房颤动组的ICH发生率高于非心房颤动组(26.7％vs.9.4％,P＜0.05),而两组之间SICH发生率差异无统计学意义(13.3％vs.6.3％,P＞0.05);心房颤动组、非心房颤动和对照组3个月预后良好的比例分别为40.0％、45.3％和16.7％,心房颤动组和非心房颤动组的3个月预后良好比例差异无统计学意义(P＞0.05),均明显高于对照组(P＜0.05或P＜0.叭);心房颤动组、非心房颤动组和对照组预后极差的比例分别为20.0％、18.8％和33.3％ (P ＞0.05).结论 伴有心房颤动的急性脑梗死患者rt-PA静脉溶栓治疗是安全有效的.
目的 觀察伴心房顫動的急性腦梗死患者使用重組組織型纖溶酶原激活物(rt-PA)靜脈溶栓的療效.方法 連續收集髮病時間＜4.5h的94例應用rt-PA靜脈溶栓治療的急性腦梗死患者,將64例無心房顫動患者作為非心房顫動組,30例伴心房顫動患者作為心房顫動組,併收集同一時段30例未行溶栓治療的伴有心房顫動的急性腦梗死患者作為對照組,比較3組患者治療前及治療後7d的美國國立衛生研究院卒中量錶(NIHSS)評分,觀察顱內齣血(ICH)和癥狀性顱內齣血(SICH)的髮生率,採用改良Rankin量錶(mRS)對3組患者3箇月預後進行分析.結果 心房顫動組和非心房顫動組溶栓後7d的NIHSS評分較溶栓前顯著降低(P＜0.05或P＜0.01);對照組治療前後NIHSS評分比較差異無統計學意義(P＞0.05);心房顫動組的ICH髮生率高于非心房顫動組(26.7％vs.9.4％,P＜0.05),而兩組之間SICH髮生率差異無統計學意義(13.3％vs.6.3％,P＞0.05);心房顫動組、非心房顫動和對照組3箇月預後良好的比例分彆為40.0％、45.3％和16.7％,心房顫動組和非心房顫動組的3箇月預後良好比例差異無統計學意義(P＞0.05),均明顯高于對照組(P＜0.05或P＜0.叭);心房顫動組、非心房顫動組和對照組預後極差的比例分彆為20.0％、18.8％和33.3％ (P ＞0.05).結論 伴有心房顫動的急性腦梗死患者rt-PA靜脈溶栓治療是安全有效的.
목적 관찰반심방전동적급성뇌경사환자사용중조조직형섬용매원격활물(rt-PA)정맥용전적료효.방법 련속수집발병시간＜4.5h적94례응용rt-PA정맥용전치료적급성뇌경사환자,장64례무심방전동환자작위비심방전동조,30례반심방전동환자작위심방전동조,병수집동일시단30례미행용전치료적반유심방전동적급성뇌경사환자작위대조조,비교3조환자치료전급치료후7d적미국국립위생연구원졸중량표(NIHSS)평분,관찰로내출혈(ICH)화증상성로내출혈(SICH)적발생솔,채용개량Rankin량표(mRS)대3조환자3개월예후진행분석.결과 심방전동조화비심방전동조용전후7d적NIHSS평분교용전전현저강저(P＜0.05혹P＜0.01);대조조치료전후NIHSS평분비교차이무통계학의의(P＞0.05);심방전동조적ICH발생솔고우비심방전동조(26.7％vs.9.4％,P＜0.05),이량조지간SICH발생솔차이무통계학의의(13.3％vs.6.3％,P＞0.05);심방전동조、비심방전동화대조조3개월예후량호적비례분별위40.0％、45.3％화16.7％,심방전동조화비심방전동조적3개월예후량호비례차이무통계학의의(P＞0.05),균명현고우대조조(P＜0.05혹P＜0.팔);심방전동조、비심방전동조화대조조예후겁차적비례분별위20.0％、18.8％화33.3％ (P ＞0.05).결론 반유심방전동적급성뇌경사환자rt-PA정맥용전치료시안전유효적.
Objective To study the effectiveness and safety of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis therapy for acute ischemic stroke in patients with atrial fibrillation (AF).Methods A total of 94 patients treated with intravenous rt-PA thrombolysis within 4.5 hours after cerebral stroke onset were analyzed and divided into two groups:a non-AF group (n =64) and an AF group (n =30).Another 30 acute ischemic stroke patients with AF without thrombolytic therapy were selected as a control group.The prognosis of the three groups was compared.The National Institute of Health Stroke Scale (NIHSS) was used for comparison among the three groups before therapy and 7 days after therapy.The incidences of intracerebral hemorrhage (ICH) and symptomatic ICH (SICH) were recorded.The patients were followed up for 90 days and their clinical outcomes were assessed by using the modified Rankin scale (mRS).Results There were no significant differences in the NIHSS scores among three groups before treatment (P ＞ 0.05).The NIHSS scores were significantly lower in the AF and non-AF groups 7 days after thrombolysis therapy than those before thrombolysis therapy (P ＜0.05 and P ＜0.01),and no significant difference in the NIHSS scores was found in the control group before and after therapy (P ＞ 0.05).The incidence of ICH was significantly higher in the AF group than in the non-AF group (26.7％ vs.9.4％,P ＜ 0.05).No significant difference in the incidence of SICH was found between the AF and non-AF groups (13.3％ vs.6.3％,P ＞ 0.05).The favorable prognosis rate was higher in the AF and nonAFgroups than in control group (40.0％ vs.16.7％,P＜0.05; 45.3％ vs.16.7％,P＜0.01).No significant difference in very unfavorable prognosis rate was found between the AF and non-AF groups (20.0％ vs.18.8％,P ＞0.05).Conclusions It is effective and safe of rt-PA thrombolysis therapy for acute ischemic stroke patients with AF.
