摘要
目的评价和分析rt-PA治疗6 h内急性脑梗死合并出血的临床意义及相关因素。方法将符合入选标准的患者随机分为A组(rt-PA 0．9 mg/kg)、B组(rt-PA 0．7 mg/kg)、C组(对照组),并将三组又分别分为克赛亚组(A1、B1、C1)和非克赛亚组(A2、B2、C2)。采用CSS及Barthel指数评定溶栓前、溶栓后24 h、3 d、7 d、90 d的疗效。结果各组的总出血发生率、48 h脑出血率、14 d脑出血发生率,A、B 组高于C组,差异有显著性。症状性脑出血率A组、B组与C组差异无显著性。90 d显效率与90 d痊愈率 A、B组高于C组,差异有显著性。90 d病死率A、B组低于C组,差异有显著性。以上各观察结果A与B 组差异无显著性,克赛亚组与非克赛亚组差异无显著性。结论rt-PA静脉溶栓6 h以内急性脑梗死会增加出血机会,但能提高疗效,降低病死率,因此,rt-PA 6 h内静脉溶栓治疗急性脑梗死是安全、显效的,剂量以0．7 mg/kg更符合国人。
Objective To evaluate the safety of thrombolytic treatment using rt-PA at early stage of acute cerebral infarction in Chinese patients, and to analyze the significance of intra - cerebral hemorrhage after therapy. Methods 206 patients within 6 hours after the onset of stroke were divided into 3 groups- group A （thrombolytie treament using rt- PA with dosage of 0.9 mg/kg over 60 minutes）, group B （thrombolytic treatment using rt-PA with dosage of 0.7 mg/kg over 60 minutes） and group C （control group without rt-PA）. Group A, group B, group C were divided into two subgroups according to using Clexane or not. Patients in subgroups A1, B1, C1 were treated with Clexane and in subgroups A2, B2, C2 were not. The Chinese Stroke Scale （CSS） and Barthel Index （BI） were used to evaluate the neurological function before and 24 hours, 3 days, 7 days, and 90 days rt-tPA. Results There was significant difference on hemorrhagic rate and cerebral hemorrhagic rate at the 48 hours and 14 days between group A, group B and group C. There was no significant difference on symptomatic cerebral hemorrhage in groups A, B and group C. There were significant differences between thrombolytic groups and group C on the effective and curative rate at 90 days after therapy. The mortality was lower in thrombolytic groups than in group C at 90 days. There was no significant difference between group A and group B , and also between the subgroups. Conclusion Thrornbolytic treatment using rt-PA intravenously in patients with acute cerebral infarction within 6 hours was effective and safe. The dosage of 0.7mg/kg was suitable for Chinese patients.
出处
《中华急诊医学杂志》
CAS
CSCD
2006年第5期457-459,共3页
Chinese Journal of Emergency Medicine
关键词
RT-PA
溶栓
脑梗死
脑出血
病死率
Actilyse （rt-PA）
Intravenous thrornbolysis
Acute cerebral infarction
Cerebral hemorrhage
Mortality rate
