【摘要】 目的评估静脉溶栓与双抗治疗急性脑梗死(ACI)的临床疗效。方法回顾性分析2016年3月至2018年3月凤翔县医院收治的85例发病4.5 h内的ACI患者的临床资料,根据治疗方式分为静脉溶栓组[重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,n=51]和双抗组(阿司匹林+氯吡格雷抗血小板治疗,n=34)。比较两组患者治疗前、治疗4 h及治疗24 h时相关实验室指标[血小板计数(PLT)、D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)],以及两组患者治疗前及治疗后24 h、7 d、14 d时美国国立卫生研究院卒中量表(NIHSS)评分的差异,并比较两组患者的临床疗效和治疗期间的不良反应情况。结果治疗前至治疗24 h时,两组患者的相关实验室指标(PLT、D-D、PT、APTT、Fib)组间效应、时间点效应及组间与时间点交互效应差异均有统计学意义(P<0.05);治疗4 h及治疗24 h时,静脉溶栓组患者的PLT、D-D、PT、APTT水平均先升高后降低,且均高于同时间双抗组,差异均有统计学意义(P<0.05);静脉溶栓组Fib水平均先降低后升高,且均低于同时间双抗组,差异均有统计学意义(P<0.05);治疗后24 h、7 d、14 d时,两组患者的NIHSS评分均较治疗前降低,且治疗后各时间点静脉溶栓组低于双抗组,差异均有统计学意义(P<0.05);静脉溶栓组患者的治疗总有效率为86.27%,明显高于双抗组的52.94%,差异有统计学意义(P<0.05);静脉溶栓组患者的死亡率为3.92%,略低于双抗组的8.83%,总不良反应率为21.56%,略高于双抗组的14.70%,但差异均无统计学意义(P>0.05)。结论 ACI发病4.5 h内予静脉溶栓治疗效果优于双抗治疗,疗效显著且安全性良好。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of intravenous thrombolysis and dual anti-platelet therapy in the treatment of acute cerebral infarction(ACI). Methods The clinical data of 85 ACI patients with a time of onset within 4.5 hours were retrospectively analyzed, who were admitted to the Fengxiang County Hospital from March2016 to March 2018. According to the treatment methods, the patients were divided into intravenous thrombolysis group(recombinant tissue plasminogen activator [rt-PA] intravenous thrombolytic therapy, n=51) and dual anti-platelet group(anti-platelet therapy of aspirin & clopidogrel, n=34). The relevant laboratory parameters, including blood platelet count(PLT), D-dimer(D-D), prothrombin time(PT), activated partial thromboplastin time(APTT), and fibrinogen(Fib), between the two groups were compared before treatment at 4 h and 24 h after treatment, as well as the difference in the score of National Institutes of Health Stroke Scale(NIHSS) between the two groups before treatment and at 24 h, 7 d and 14 d after treatment, and the clinical efficacy of the two groups and the adverse reactions during treatment. Results Before treatment to 24 h after treatment, the relevant laboratory parameters(PLT, D-D, PT, APTT, Fib) between the two groups had statistically significant differences on inter-group effects, time-point effects, and interactions between inter-groups and timepoint(P<0.05). At 4 h and 24 h after treatment, the levels of PLT, D-D, PT and APTT in the intravenous thrombolysis group increased first and then decreased, and were higher than those in the simultaneous dual anti-platelet group(P<0.05). The Fib level in the intravenous thrombolysis group decreased first and then increased, and both were lower than that in the simultaneous dual anti-platelet group(P<0.05). At 24 h, 7 d and 14 d after treatment, the NIHSS scores in the two groups were lower than that before treatment, and the scores in the intravenous thrombolysis group were lower than those in the dual anti-platelet group at each time point after treatment(P<0.05). The total effective rate of treatment in the intravenous thrombolysis group was 86.27%, which was higher than 52.94% in the dual anti-platelet group(P<0.05).In the intravenous thrombolysis group, the mortality rate was slightly lower than that in the dual anti-platelet group(3.92% vs 8.83%), and the total adverse reaction rate was slightly higher than that in the dual anti-platelet group(21.56%vs 14.70%), both differences were not statistically significant(P>0.05). Conclusion Intravenous thrombolytic therapy for ACI with a time of onset within 4.5 hours has better treatment effects than dual anti-platelet therapy, with remarkable efficacy and good safety.更多还原