【作者】 张彬；

【导师】 孙晓江；

【作者基本信息】 上海交通大学 ， 神经内科， 2008， 硕士

【摘要】 目的:探讨急性脑梗死溶栓治疗的有效性及安全性。同时分析和比较动脉溶栓和静脉溶栓的疗效和安全性,预后相关因素的分析。材料与方法:收集从2001到2007年有完整资料的溶栓病例共111例,静脉溶栓90例,动脉溶栓21例,入选标准参照NINDS研究略有改动。疗效分析:分析比较溶栓前、后的NIHSS、ESS评分,评定溶栓的短期疗效,通过3个月的mRS评分对患者的长期预后进行评估。安全性:治疗24小时内症状性颅内出血的比例和3月内死亡率。结果:1.静脉溶栓组:溶栓后预后良好的比例为45.6%,sICH发生率为6.7%,死亡率为13.3%。3小时内溶栓和3-6小时溶栓的疗效和安全性无差异,年龄≤60岁组和61-81岁组溶栓的疗效和安全性无差异。房颤病人和非房颤病人预后无差异,但房颤病人出血的危险性和死亡率相对增高。基线的NIHSS评分是溶栓后出血的相关因素(OR=1.914,P=0.030<0.05,95% CI 1.065 to 3.440)。14天的NIHSS评分是溶栓预后的相关因素(OR=3.235, P=0.000<0.01,95% CI 1.799 - 5.819)2.动脉溶栓组:溶栓后预后良好的比例为42.9%,sICH发生率为9.5%,死亡率为9.5%。大脑前动脉闭塞的都预后良好;大脑中动脉闭塞的预后良好占46.7%;颈内动脉和基底动脉闭塞的都预后不良。再通等级为III级的,预后良好的58.3%;再通等级为II级的,预后良好的25%。3.动静脉溶栓的比较:静脉组和动脉组疗效和安全性的比较无差异(P>0.05)。大脑中动脉闭塞,静脉溶栓预后良好的占38.8%,动脉溶栓预后良好的占46.2%。结论:1.静脉溶栓预后同年龄、治疗时间窗无关。房颤病人的出血率和死亡率较高。2.动脉溶栓血管的再通率和闭塞的部位与预后有关。3.动脉溶栓和静脉溶栓的疗效和安全性没有差异,大脑中动脉闭塞,动脉溶栓效果较好。更多还原

【Abstract】 Objective:To investigate the efficacy and safety of thrombolysis, and to compare the outcome and the safety between the intravenous and intra-arterial thrombolysis, and analysis the factors related to the outcome.Methods:110 cases of acute ischemic stroke patients were treated with rt-PA. Comparing the scores of the NIHSS and ESS before and after thrombolysis, to evaluate the safety and efficiency of thrombolysis,using mRS to evaluate the prognosis after three month of thrombolysis. Results:1. Intravenous thrombolysis: the patients with good outcome were 45.6%, the incidence of the SICH was 6.7%, and the death rate was 13.3%. The patients’age and the time window had no relation with the safety of thrombolysis. The effeciency of affiliated patients was similar to the non-affiliated patients, but affiliated patients had higher bleeding rate and death rate. The baseline NIHSS cores was related to the symptomatic intracranial haemorrhage(OR=1.914,P=0.030<0.05,95% CI 1.065 to 3.440), and the 14 days NIHSS scores was related to the outcome (OR=3.235, P=0.000<0.01,95% CI 1.799 - 5.819).2. Intra-arterial thrombolysis: the patients with good outcome were 42.9%, the incidence of the SICH was 9.5%, and the death rate was 9.5%. The occlusion position and the recanalization rate had relation with the outcome.3. The efficiency and the outcome between the Intravenous thrombolysis and intra-arterial thrombolysis had no different. For the MCA occlusion, the intra-arterial thrombolysis had a better outcome.Conclusions:1. The outcome of the intravenous thrombolysis had no different between different age and time window. The affiliated patients had higher bleeding rate and death rate2. The outcome of the intra-arterial thrombolysis was related to the recanalization rate and the occlusion position.3. The intravenous thrombolysis and the intra-arterial thrombolysis were relatively safe and effective. The intra-arterial thrombolysis for the MCA occlusion had a better outcome.更多还原