【摘要】 目的探究阿替普酶治疗老年和高龄急性脑梗死的疗效和安全性,为有效治疗该病提供方法。方法选取2016年7月—2019年7月于阜阳市人民医院就诊的老年急性脑梗死患者90例,根据年龄分为老年组(年龄65～80岁,=50)和高龄组(年龄>80岁,=40)。2组患者入院后均接受阿替普酶静脉溶栓。采用NIHSS评估2组疗效,根据2组治疗后14 d累积有效率绘制生存曲线,并观察2组患者不良反应和死亡情况,对2组结果进行比较与分析。结果 2组年龄、合并高血压和合并房颤比例差异均有统计学意义(<0.05)。术后14 d,老年组和高龄组治疗有效率分别为86.0%和85.0%,均较高,但差异无统计学意义(>0.05);高龄组平均有效时间明显长于老年组[(8.4±2.6) d (6.8±1.9) d,<0.05]。Kaplan-Meier法并Log-rank检验提示2组累积有效率差异无统计学意义(>0.05),高龄组累积有效率下降缓慢,老年组累积有效率下降较快。2组颅内出血、心律失常、呼吸道出血、胃肠道出血、牙龈出血、肝酶异常、血红蛋白降低发生率、总不良反应发生率和死亡率差异无统计学意义(>0.05)。结论阿替普酶治疗老年和高龄急性脑梗死,效果显著,安全性高,但相比老年急性脑梗死,阿替普酶治疗高龄急性脑梗死时起效较慢。更多还原

【Abstract】 Objective To explore the curative effect and application safety of alteplase in the treatment of acute cerebral infarction in the cases at old and advanced age. Methods 90 elderly with acute cerebral infarction hospitalized during the period from July 2016 to July 2019 were enrolled and divided into 2 groups: old age group(aged from 65 to 80 years old, =50) and advanced age group(aged over 80 years old, =40); intravenous thrombolysis with alteplase was made to all the cases in the2 groups after admission; the National Institutes of Health Stroke Scale(NIHSS) was applied in evaluating the curative effect and the survival curves were drawn according to the cumulative effectiveness within 14 days after treatment, a comparative observation of the mortality and adverse reactions was performed between the 2 groups. Results There existed statistical differences in age, ratio of hypertension complicated and ratio of atrial fibrillation complicated between the 2 groups( <0.05); on the 14 th day after treatment, the effective rate was high in both groups: 86.0% in old age group and 85.0% in advanced age group( >0.05); the effective drug duration was longer in advanced age group than that in old age group [(8.4±2.6 d).(6.8±1.9 d),<0.05]; Kaplan-Meier method and Log-rank test indicated that the cumulative effectiveness was of no statistical significance between the 2 groups( >0.05); the cumulative effectiveness in advanced age group dropped down slowly while that in old age group dropped down relatively fast; no statistical differences were found between the2 groups in intracranial hemorrhage, arrhythmia, respiratory tract bleeding, gastrointestinal bleeding, gingival hemorrhage, liver enzyme abnormalities, hemoglobin reduction, total adverse reaction rate and mortality( >0.05). Conclusions Alteplase is effective and safe in the treatment of acute cerebral infarction in cases at old age and advanced age; alteplase has a slower effect onset in advanced age cases than in old age cases.更多还原