不同剂量重组组织型纤溶酶原激活剂静脉溶栓治疗对超早期急性脑梗死预后的影响

被引：22

作者：

闫立荣

孙玉衡

机构：

[1] 北京大学第四临床医学院神经内科

来源：

中国卒中杂志 | 2008年 / 11期

关键词：

重组组织溶纤溶酶原激活剂; 脑梗死; 静脉溶栓;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

1002 ;

摘要：

目的通过对超早期脑梗死患者接受不同剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的分析,探讨使用rt-PA对超早期脑梗死预后的影响。方法超早期脑梗死患者308例,根据家属的意愿及是否签署溶栓治疗知情同意书分别给予溶栓治疗和非溶栓治疗。溶栓组221例,接受rt-PA静脉溶栓,其中92例给予rt-PA0.9mg/kg,发病在3h内68例,>3-≤4h内9例,>4-≤6h内15例。129例给予rt-PA0.6-0.8mg/kg,发病在3h内72例,>3-≤4h内24例,>4-≤6h内33例。对照组87例,未应用rt-PA治疗。记录各组在基线、治疗24h、发病90dNIHSS评分、Barthel指数。预后良好定义为发病90dBarthel指数≥95;颅内出血分为症状性颅内出血和非症状性颅内出血。同时记录随访期间的血管性死亡事件和卒中再发事件。应用logistic多因素分析预后的独立相关因素。结果预后良好的独立相关因素为患者接受治疗前NIHSS评分(OR=2.067,95%CI1.201-3.556,P=0.009),冠心病史(OR=1.942,95%CI1.040-3.625,P=0.037)和溶栓治疗(rtPA0.9mg/kg时,OR=0.414,95%CI0.207-0.826,P=0.012;rtPA0.6-0.8mg/kg时,OR=0.261,95%CI0.137-0.497,P<0.01)。症状性颅内出血发生率在rtPA0.9mg/kg溶栓组与rtPA0.6-0.8mg/kg溶栓组分别为3.3%(3/92)和4.7%(6/129),差别无统计学意义。结论静脉应用rt-PA溶栓治疗超早期急性脑梗死可获得较好的预后,不同剂量rt-PA(0.6-0.8mg/kgvs0.9mg/kg)对预后的影响无统计学差异,伴有心房颤动、糖尿病史将可能影响预后。

引用

页码：808 / 813

页数：6

共 18 条

[1] 临床应用重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中专家共识 [J].

王伊龙 .

中华内科杂志, 2006, (07) :613-614

[2] Large ischemic lesions on diffusion-weighted imaging done before intravenous tissue plasminogen activator thrombolysis predicts a poor outcome in patients with acute stroke [J].

Kimura, Kazumi ;

Iguchi, Yasuyuki ;

Shibazaki, Kensaku ;

Terasawa, Yuka ;

Inoue, Takeshi ;

Uemura, Junichi ;

Aoki, Junya .

STROKE, 2008, 39 (08) :2388-2391

[3] Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke [J].

Arenillas, J. F. ;

Ispierto, L. ;

Millan, M. ;

Escudero, D. ;

de la Ossa, N. Perez ;

Dorado, L. ;

Guerrero, C. ;

Serena, J. ;

Castillo, J. ;

Davalos, A. .

NEUROLOGY, 2008, 71 (03) :190-195

[4]

Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes[J] . S Sato,K Toyoda,T Uehara,N Toratani,C Yokota,H Moriwaki,H Naritomi,K Minematsu.Neurology . 2008 (24,)

[5] A pilot randomized clinical safety study of sonothrombolysis augmentation with ultrasound-activated perflutren-lipid microspheres for acute ischemic stroke [J].

Alexandrov, Andrei V. ;

Mikulik, Robert ;

Ribo, Marc ;

Sharma, Vijay K. ;

Lao, Annabelle Y. ;

Tsivgoulis, Georgios ;

Sugg, Rebecca M. ;

Barreto, Andrew ;

Sierzenski, Paul ;

Malkoff, Marc D. ;

Grotta, James C. .

STROKE, 2008, 39 (05) :1464-1469

[6]

Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion: Results From a Randomized Study[J] . Stroke . 2008 (5)

[7]

Albumin Therapy Augments the Effect of Thrombolysis on Local Vascular Dynamics in a Rat Model of Arteriolar Thrombosis: A Two-Photon Laser-Scanning Microscopy Study[J] . Hee-Pyoung Park,Anitha Nimmagadda,Richard A. DeFazio,Raul Busto,Ricardo Prado,Myron D. Ginsberg.Stroke . 2008 (5)

[8] Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging [J].

Singer, Oliver C. ;

Humpich, Marek C. ;

Fiehler, Jens ;

Albers, Gregory W. ;

Lansberg, Maarten G. ;

Kastrup, Andras ;

Rovira, Alex ;

Liebeskind, David S. ;

Gass, Achim ;

Rosso, Charlotte ;

Derex, Laurent ;

Kim, Jong S. ;

Neumann-Haefelin, Tobias .

ANNALS OF NEUROLOGY, 2008, 63 (01) :52-60

[9]

Bleeding Risk Analysis in Stroke Imaging Before ThromboLysis （BRASIL）: Pooled Analysis of T2*-Weighted Magnetic Resonance Imaging Data From 570 Patients[J] . Jens Fiehler,Gregory W. Albers,Jean-Martin Boulanger,Laurent Derex,Achim Gass,Niels Hjort,Jong S. Kim,David S. Liebeskind,Tobias Neumann-Haefelin,Salvador Pedraza,Joachim Rother,Peter Rothwell,Alex Rovira,Peter D. Schellinger,Johannes Trenkler.Stroke . 2007 (10)

[10] Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation [J].

Tountopoulou, Argyro ;

Ahl, Bjoern ;

Weissenborn, Karin ;

Becker, Hartmut ;

Goetz, Friedrich .

NEURORADIOLOGY, 2008, 50 (01) :75-83

← 1 2 →