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目的:探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗超早期脑梗死的临床疗效及预后。方法 :选取我院2009年5月至2014年5月收治的符合入选条件的超早期脑梗死患者336例,行rt-PA静脉溶栓治疗(溶栓组);选取同期非溶栓常规治疗的超早期脑梗死患者306例作为对照组。比较2组患者治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、治疗效果、24 h内及3个月并发症及预后情况。结果:2组患者治疗前的NIHSS差异无统计学意义。治疗后2组患者的NIHSS分值均有下降,2组间比较差异具有统计学意义(P<0.05);溶栓组的总有效率为93.5%,明显高于非溶栓治疗的80.6%(P<0.05);2组患者药物过敏发生率、血管再闭塞率等差异无统计学意义(P>0.05);溶栓治疗组能显著改善患者3个月预后(P<0.05)。24 h内溶栓组脑出血率高于对照组(P<0.05),3个月2组患者脑出血率无显著差异(P>0.05)。24 h内病死率溶栓组高于对照组(P<0.05),3个月病死率溶栓组仍高于对照组(P<0.05)。结论 :rt-PA静脉溶栓治疗安全有效,有利于降低致残率,提高患者的生活质量。对于符合溶栓指征的急性脑梗死患者推荐早期应用rt-PA静脉溶栓治疗。溶栓相关性脑出血使溶栓组患者死亡率增加。
Objective: To investigate the clinical effect and prognosis of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in the treatment of ultra-early cerebral infarction. Methods: A total of 336 patients with ultra-early cerebral infarction who met the eligibility criteria from May 2009 to May 2014 in our hospital were treated with rt-PA intravenous thrombolysis (thrombolytic group). The patients who underwent conventional thrombolytic therapy 306 patients with ultra-early cerebral infarction as a control group. The National Institutes of Health Stroke Scale (NIHSS) score, treatment outcome, intra-24-h and 3-month complications and prognosis were compared between the two groups before and after treatment. Results: There was no significant difference in NIHSS between the two groups before treatment. The NIHSS scores of two groups decreased after treatment, the difference between the two groups was statistically significant (P <0.05). The total effective rate of thrombolytic group was 93.5%, significantly higher than that of non-thrombolytic therapy (80.6%) P <0.05). There was no significant difference in the incidence of drug allergy and vascular reocclusion among the two groups (P> 0.05). The thrombolytic therapy group could significantly improve the prognosis of patients for 3 months (P <0.05). Within 24 hours, the rate of cerebral hemorrhage in thrombolytic group was higher than that in control group (P <0.05). There was no significant difference in cerebral hemorrhage between two groups in 3 months (P> 0.05). The mortality rate within 24 h was higher in the thrombolytic group than in the control group (P <0.05). The 3-month mortality was still higher in the thrombolytic group than in the control group (P <0.05). Conclusion: rt-PA intravenous thrombolytic therapy is safe and effective, which is beneficial to reduce the morbidity and improve the quality of life of patients. For patients with acute cerebral infarction in line with thrombolytic indications recommended early rt-PA intravenous thrombolytic therapy. Thrombolysis-related intracerebral hemorrhage increased mortality in patients receiving thrombolysis.