CAJ | 학술논문

目的探究阿替普酶静脉溶栓治疗急性脑梗死的量效时效及临床应用的安全性.方法选取急性脑梗死患者110例,其中时间窗≤3.0h50例,按随机数字表法分为A组和B组,每组25例;时间窗3.1～4.5h60例,按随机数字表法分为C组和D组,每组30例.A组和C组给予阿替普酶0.6 mg/kg(最高用量60 mg)静脉溶栓治疗;B组和D组给予阿替普酶0.9 mg/kg(最高用量90 mg)静脉溶栓治疗.观察四组患者治疗前和治疗后1h、24 h、7d、30 d、90 d的美国国立卫生研究院卒中量表(NIHSS)评分,比较四组临床疗效,统计四组并发症发生率和病死率,于治疗后90 d行改良Rankin量表(mRS)评分评价预后.结果四组治疗后1h、24 h、7d、30 d、90 d NIHSS评分均较治疗前明显降低,差异有统计学意义(P＜0.05),而且NIHSS评分随着时间的延长有明显降低的趋势.A组与B组、C组与D组同一时间点NIHSS评分比较差异无统计学意义(P＞0.05).A组、D组分别与B组、C组并发症发生率和治疗后90d内病死率比较差异无统计学意义(P＞0.05).A组预后良好率最大为76.00％(19/25),C组预后良好率最小为43.33％(13/30),B组为64.00％(16/25),D组为53.33％(16/30).A组与B组比较差异无统计学意义(x2=0.620,P＞0.05),C组与D组比较差异无统计学意义(x2=0.069,P＞0.05).结论治疗窗≤3.0h低剂量阿替普酶静脉溶栓治疗急性脑梗死同样安全有效,治疗窗3.1～4.5h常规剂量阿替普酶静脉溶栓治疗急性脑梗死临床效果较好且安全.
목적 탐구아체보매정맥용전치료급성뇌경사적량효시효급림상응용적안전성.방법 선취급성뇌경사환자110례,기중시간창≤3.0h50례,안수궤수자표법분위A조화B조,매조25례;시간창3.1～4.5h60례,안수궤수자표법분위C조화D조,매조30례.A조화C조급여아체보매0.6 mg/kg(최고용량60 mg)정맥용전치료;B조화D조급여아체보매0.9 mg/kg(최고용량90 mg)정맥용전치료.관찰사조환자치료전화치료후1h、24 h、7d、30 d、90 d적미국국립위생연구원졸중량표(NIHSS)평분,비교사조림상료효,통계사조병발증발생솔화병사솔,우치료후90 d행개량Rankin량표(mRS)평분평개예후.결과 사조치료후1h、24 h、7d、30 d、90 d NIHSS평분균교치료전명현강저,차이유통계학의의(P＜0.05),이차NIHSS평분수착시간적연장유명현강저적추세.A조여B조、C조여D조동일시간점NIHSS평분비교차이무통계학의의(P＞0.05).A조、D조분별여B조、C조병발증발생솔화치료후90d내병사솔비교차이무통계학의의(P＞0.05).A조예후량호솔최대위76.00％(19/25),C조예후량호솔최소위43.33％(13/30),B조위64.00％(16/25),D조위53.33％(16/30).A조여B조비교차이무통계학의의(x2=0.620,P＞0.05),C조여D조비교차이무통계학의의(x2=0.069,P＞0.05).결론 치료창≤3.0h저제량아체보매정맥용전치료급성뇌경사동양안전유효,치료창3.1～4.5h상규제량아체보매정맥용전치료급성뇌경사림상효과교호차안전.
Objective To explore the dose-effect,time-effect and safety of alteplase in the treatment of acute cerebral infarction.Methods One hundred and ten patients with acute cerebral infarction were selected,among whom 50 patients whose time window ≤3.0 h were divided into group A and group B by random digits table method with 25 cases each,and 60 patients whose time window 3.1-4.5 h were divided into group C and group D by random digits table method with 30 cases each.The patients in group A and group C received alteplase 0.6 mg/kg (maximum dose 60 mg) intravenous thrombolysis;the patients in group B and group D received alteplase 0.9 mg/kg (maximum dose 90 mg) intravenous thrombolysis.The national institutes of health stroke scale (NIHSS) scores before treatment and 1 h,24 h,7 d,30 d and 90 d after treatment were observed in the 4 groups.The therapeutic effect,complication incidence and fatality rate were compared.The prognosis was estimated by modified Rankin scale (mRS) score 90 d after treatment.Results The NIHSS scores 1 h,24 h,7 d,30 d and 90 d after treatment were significantly lower than those before treatment in the 4 groups,and there were statistical differences (P ＜ 0.05).The NIHSS score decreased significantly with time.There were no statistical differences in NIHSS score between group A and group B,group C and group D.There were no statistical differences in complication incidence and fatality rate 90 d aftcr treatment in group A and group D compared with group B and group C (P＞ 0.05).The rate of eusemia in group A was 76.00％ (19/25),in group B was 64.00％ (16/25),in group C was 43.33％ (13/30),and in group D was 53.33％ (16/30).And there were no statistical differences between group A and group B (x2 =0.620,P ＞0.05),and between group C and group D (x2 =0.069,P＞ 0.05).Conclusions The low dose alteplase is also effective and safe to acute cerebral infarction patients at time window ≤ 3 h.It is also effective and safe to acute cerebral infarction patients at time window 3.0-4.5 h at standard dose.