【摘要】 目的探讨不同时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的临床疗效。方法选取2016年8月~2017年8月我院收治的70例椎-基底动脉系统脑梗死患者为研究对象,所有患者均经多模式MRI证实且行rt-PA静脉溶栓治疗,根据患者溶栓治疗时间窗不同,将其分为<4.5 h组(35例)和4.5~9 h组(35例),比较两组神经功能缺损量表(national institutes of health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分及改良Rankin量表(modified Rankin scale,mRS)评分,观察两组脑出血发生情况。结果与治疗前比较,<4.5 h组和4.5~9 h组患者溶栓后24 h、14 d、30 d及90 d的NIHSS评分显著降低(P<0.05),BI评分显著升高(P<0.05),而两组患者在rt-PA静脉溶栓治疗后的NIHSS评分及BI评分比较,差异无统计学意义(P>0.05);两组rtPA静脉溶栓后90 d的mRS评分及预后良好率比较均无明显差异(P>0.05)。3 m随访期内,<4.5 h组脑出血发生率为5.71%,4.5~9 h组脑出血发生率为8.57%,两组比较差异无统计学意义(P>0.05)。结论 I扩大时间窗至9 h对椎-基底动脉系统脑梗死行rt-PA静脉溶栓治疗安全有效,因此,对于治疗时间窗为4.5 h~9 h的椎-基底动脉系统脑梗死也可行rt-PA静脉溶栓治疗。更多还原

【Abstract】 Objective To explore the clinical efficacy of different time window recombinant tissue-type plasminogen activator intravenous thrombolysis in treatment of vertebrobasilar system cerebral infarction. Methods Seventy patients with vertebrobasilar cerebral infarction admitted to our hospital from August 2016 to August 2017 were enrolled in this study. All patients were confirmed by multimodal MRI and treated with recombinant tissue plasminogen activator intravenous thrombolysis. According to thrombolytic therapy The time windows were different,which were divided into < 4. 5 h group( 35 cases) and 4. 5 ~ 9 h group( 35 cases). The scores of national institutes of health stroke scale,Barthel index scores and modified Rankin scale score were measured to observe the occurrence of cerebral hemorrhage in both groups. Results The scores of NIHSS at 24 h,14 d,30 d and 90 d after thrombolytic therapy in both groups were significantly lower than those before thrombolysis( P < 0. 05). There was no significant difference in NIHSS scores between the two groups before and after thrombolytic therapy( P > 0. 05). The Barthel index scores of 14 th,30 th and 90 th day after thrombolysis in both groups were significantly higher than those before thrombolysis( P < 0. 05),but there was no significant difference in Barthel index between the two groups before and after thrombolysis( P > 0. 05). There was no significant difference between the two groups in the improved Rankin scale 90 days and the good prognosis rate 90 days after thrombolysis( P > 0. 05)The rate of intracerebral hemorrhage was 5. 71% in 4. 5 ~ 9 h group,the incidence of cerebral hemorrhage was 8. 57%.There was no significant difference between the two groups( P > 0. 05). Conclusions Extending the time window of rtPA intravenous thrombolytic therapy of vertebrobasilar cerebral infarction efficacy and conventional time window effect is relatively safe,so the treatment of time window 4. 5 ~ 9 h of vertebrobasilar cerebral infarction is feasible rt-PA intravenous thrombolytic therapy.更多还原