【摘要】 目的探讨轻型缺血性卒中患者接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的效果及安全性。方法回顾性连续纳入2016年4月至2018年1月广州市第一人民医院神经内科急性轻型脑梗死住院患者117例,均为发病<4.5 h,且美国国立卫生院卒中量表(NIHSS)评分≤5分。根据是否行rt-PA静脉溶栓治疗,将117例患者分为静脉溶栓组(64例)和非静脉溶栓组(53例)。(1)记录两组患者基线及临床资料,并比较其差异。基线资料包括年龄、性别、心脑血管病一般危险因素(高血压病、高脂血症、糖尿病、心房颤动病史、烟酒史);临床资料包括入院时NIHSS评分、起病至溶栓时间、致残性卒中症状等。(2)对两组患者治疗后24 h、7 d、90 d的神经功能进行评价,包括NIHSS评分和(或)改良Rankin量表(mRS)评分。(3)记录治疗后大动脉狭窄的影像学检查结果及不良事件发生率。结果 (1)两组患者男性、脑梗死相关危险因素(高血压病、糖尿病、高脂血症、心房颤动、烟酒史)、致残性卒中症状以及年龄、入院时NIHSS评分等基线资料的差异均无统计学意义(均P> 0.05)。静脉溶栓组患者起病至溶栓时间为75～260 min,中位时间为161.5(129.5,185.0) min。(2)两组患者治疗后24 h、7 d NIHSS评分的差异均无统计学意义(均P>0.05)。静脉溶栓组90 d预后良好者中,伴致残性卒中症状者预后良好占比为9/10,伴非致残性卒中症状者预后良好率为81.5%(44/54),二者预后良好比例的差异无统计学意义(P=0.512);非静脉溶栓组90 d预后良好者中,伴致残性卒中症状者预后良好占比为8/12,伴非致残性卒中症状者预后良好率为65.9%(27/41),二者预后良好比例的差异无统计学意义(P=0.413)。静脉溶栓组90 d预后良好率高于非静脉溶栓组,组间差异有统计学意义[82.8%(53/64)比66.0%(35/53),χ~2=4.376,P=0.036]。(3)静脉溶栓组在治疗期间出现脑出血转化2例,其他部位出血而中止抗血小板聚集治疗1例,溶栓后桥接脑血管取栓术并发颅内未出血致死1例;非静脉溶栓组治疗期间未发生出血及病死率事件,两组脑出血转化发生率及病死率的差异均无统计学意义(均P> 0.05)。(4)静脉溶栓组有3例患者在溶栓后出现症状加重,行桥接机械取栓治疗,其中2例患者溶栓前均评估为非致残性卒中,1例颈动脉狭窄患者在住院期间行颈动脉支架置入术。非静脉溶栓组中择期行颈动脉支架置入术及右侧大脑中动脉M1段支架置入术者各1例。两组患者颅内大血管狭窄发生率、颅外大血管发生率及总狭窄率的差异均无统计学意义(均P> 0.05)。结论无论伴或不伴致残性卒中症状,对于符合适应证的轻型缺血性卒中患者应用静脉溶栓治疗可能安全、有效。更多还原

【Abstract】 Objective To investigate the effectiveness and safety of intravenous thrombolysis with recombinant tissue plasminogen activator( rt-PA) in patients with minor ischemic stroke.Methods From April 2016 to January 2018,117 consecutive patients with acute mild cerebral infarction admitted to the Department of Neurology,Guangzhou First People’ s Hospital were enrolled retrospectively.Their onset was < 4.5 h and the National Institutes of Health Stroke Scale( NIHSS) score ≤5.According to whether performing intravenous thrombolysis or not,117 patients were divided into intravenous thrombolysis group( n = 64) and non-venous thrombolysis group( n = 53).( 1) The baseline and clinical data were recorded for both groups and their differences were compared.Baseline data included age,gender,general risk factors for cardiovascular and cerebrovascular diseases( hypertension,hyperlipidemia,diabetes,atrial fibrillation history,tobacco and alcohol history); the clinical data included the NIHSS score at admission,time from onset to thrombolysis,and disabled stroke symptoms,etc.( 2) The neurological function of both groups of patients at 24 h,7 d,and 90 d after treatment was evaluated,including the NIHSS score and/or the modified Rankin scale( mRS) score.( 3) The results of imaging examination of the aortic stenosis and the incidence of adverse events were recorded.Results( 1) There were no significant differences in baseline data of males,cerebral infarction-related risk factors( hypertension,diabetes,hyperlipidemia,atrial fibrillation,tobacco and alcohol history),the proportion of disabled stroke symptom as well as age,the NIHSS score at admission between the two groups( all P > 0.05).In the intravenous thrombolysis group,the time from onset to thrombolysis was 75-260 min,and the median time was 161.5( 129.5,185.0) min.( 2) There were no significant differences in the NIHSS scores at 24 h and 7 d after treatment between the two groups( P > 0.05).Among the patients with good prognosis at 90 d of intravenous thrombolysis,9/10 had good prognosis in patients with disabled stroke symptom and 81.5%( 44/54) had good prognosis in those with non-disabled stroke symptom.There was no significant difference in the proportion of good prognosis between the two groups( P = 0.512).Among the non-intravenous thrombolysis group with good prognosis at90 d,8/12 had good prognosis in patients with disabled stroke,and the good prognosis rate in those with non-disabling stroke was 65.9%( 27/41).There was no significant difference in the proportion of good prognosis( P = 0.413).The good prognosis rate of the intravenous thrombolytic group at 90 d was higher than that of the non-intravenous thrombolysis group.The difference between the groups was statistically significant( 82.8 % [53/64] vs.66.0 % [35/53 ],χ~2= 4.376,P = 0.036).( 3) In the intravenous thrombolysis group,two patients developed intracerebral hemorrhage transformation during the treatment period; one patient stopped anti-platelet aggregation treatment because of hemorrhage in other parts; one died of intracranial hemorrhage after thrombolytic bridging of cerebrovascular thrombectomy.There were no bleeding and death events during the treatment in the non-intravenous thrombolysis group.There were no significant differences in the incidence of intracerebral hemorrhage transformation and mortality between the two groups( P > 0.05).( 4) The symptoms in three patients in the intravenous thrombolysis group aggravated,they were treated with the bridge mechanical thrombectomy.Two of them were assessed as non-disabled stroke before thrombolysis,and one patient with carotid artery stenosis underwent carotid artery stent implantation during hospitalization.In the non-intravenous thrombolysis group,1 patient underwent carotid artery stent implantation and 1 underwent right middle cerebral artery M1 stent implantation.There was no significant difference in the incidence of intracranial macrovascular stenosis,extracranial macrovascular stenosis and total stenosis rate between the two groups( P > 0.05).Conclusion Intravenous thrombolysis is safe and effective for mild ischemic stroke patients with or without disability.更多还原