| 余国鹏 杭州市中医院 急诊科.不同rt-PA静脉溶栓时间对急性脑梗死合并房颤患者早期疗效及远期预后的影响比较[J].浙江中西医结合杂志,2018,28(4): |
| 不同rt-PA静脉溶栓时间对急性脑梗死合并房颤患者早期疗效及远期预后的影响比较 |
| The influence of early curative effect and the long-term prognosis with recombinant tissue type plasminogen activator(rt-PA)in different time windows on acute cerebral infarction patients with atrial fibrillation |
| 投稿时间：2017-06-20 修订日期：2017-12-01 |
| DOI： |
| 中文关键词: 重组组织型纤溶酶原激活剂 脑梗死 房颤 溶栓时间窗 预后 |
| 英文关键词: |
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| 中文摘要: |
| 目的 比较不同rt-PA静脉溶栓时间对急性脑梗死合并房颤患者早期疗效及远期预后的影响。 方法 回顾性分析25例行rt-PA静脉溶栓治疗的急性脑梗死合并房颤患者的临床资料，按发病至溶栓时间的长短分为研究组和对照组，研究组（发病至溶栓时间为3.0h-4.5h）13例，对照组（发病至溶栓时间＜3.0h）12例，比较两组患者的NISSH评分、90d mRS评分及脑出血转化率，分析两组患者的早期疗效及远期预后。 结果 溶栓后7d，两组患者的NISSH评分较均溶栓后24h显著下降（t=2.2，2.0，P＜0.05），组间比较差异均无统计学意义（P＞0.05），对照组溶栓后24h的疗效明显优于研究组（χ2=4.8，P＜0.05），两组患者溶栓后7d的疗效比较，差异无统计学意义（P＞0.05）；两组患者的远期疗效、出血性脑梗死型和症状性颅内出血型的转化率比较，差异均无统计学意义（P＞0.05），研究组脑实质出血型转化率（46.2%）远高于对照组（8.3%），差异存统计学意义（χ2=4.4，P＜0.05）。 结论 3小时内进行rt-PA静脉溶栓治疗可明显改善急性脑梗死合并房颤患者的短期神经功能，而3-4.5小时内进行rt-PA静脉溶栓治疗会增加其脑实质出血的风险，但不对症状性颅内出血造成影响。不同rt-PA静脉溶栓时间对急性脑梗死合并房颤患者的远期疗效无明显差异，均可有效改善预后。 |
| 英文摘要: |
| Objective To analyze the influence of early curative effect and the long-term prognosis with rt-PA in different time windows on acute cerebral infarction patients with atrial fibrillation. Methods The clinical data of 25 acute cerebral infarction patients with atrial fibrillation who accpted the intravenous thrombolysis treatment were retrospective analyzed.According to the duration of onset to thrombolysis ,they were divided into research group and the control group, the research team (onset to thrombolysis time was 3.0h-4.5h) had 13 cases, control group (onset to thrombolysis time was< 3.0 h) had 12 cases,compared NISSH score, 90 d, mRS score and cerebral hemorrhage conversion of two groups ,analyzed early efficacy and long-term prognosis of two groups . Results After the -7d thrombolytic , the NISSH scores of the two groups were significantly lower than the-24 hours thrombolysis(t= 2.2, 2.026, P < 0.05), and the comparison of two groups was not statistically significant (P > 0.05);the treatment effect of control group after the 24h-thrombolytic was obviously better than the research group (χ2=4.8， P < 0.05), the comparisonof treatment effect of two groups after the 7d-thrombolysi was no statistically significant difference (P > 0.05).Long curative effect in two groups of patients, type of hemorrhagic cerebral infarction and symptomatic intracranial blood type conversion rate comparison, there were no statistically significant difference (P > 0.05), the team parenchymal out blood type conversion rate (46.2%) was much higher than the control group (8.3%), and saved statistically significant difference (χ2 =4.4, P < 0.05). Conclusion 3 hours for rt - PA intravenous thrombolysis treatment can obviously improve the acute cerebral infarction with short-term neural function in patients with atrial fibrillation. And 3-4.5 hours for rt - PA intravenous thrombolysis treatment can increase the risk of the parenchymal hemorrhage, but not affect the symptomatic intracranial hemorrhage. There were no significant differences in the long-term efficacy of the rt-pa intravenous thrombolysis in patients with af, and the prognosis was significantly improved. |
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