摘要
目的对阿替普酶静脉溶栓正常剂量与小剂量对超高龄心源性脑栓塞患者治疗中的有效性和安全性进行分析。方法采用前瞻性研究方法,选择本地区三家医院卒中中心收治的超高龄心源性脑栓塞患者,将其分为低剂量组和标准剂量组,对两组临床疗效,治疗前后的NIHSS评分变化、FIB、PT、IL-1β、TNF-α以及改良Rankin量表(mRS)评分进行对比,并比较两组患者治疗后36h症状性颅内出血发生率以及90 d死亡情况。结果治疗后正常剂量组的总有效例数为30例,占71.43%,而低剂量组的总有效例数为40例,占95.24%,比较差异有统计学意义(P<0.05);两组治疗前的NIHSS评分、mRS评分相比,差异均无统计学意义(P>0.05);但是两组治疗后相较于治疗前,NIHSS评分、mRS评分均有明显下降(P<0.05),但是从下降幅度来看,低剂量组相比正常剂量组NIHSS评分、mRS评分下降幅度更大(P<0.05);两组治疗治疗48 h后相较于治疗前血浆纤维蛋白(FIB)水平和凝血酶原时间(PT)均发生明显差异,前者降低,后者升高,均有统计学意义(P<0.05),但治疗后两组组间的FIB水平和PT比较差异无统计学意义(P>0.05)。两组治疗前的IL-1β、TNF-α的水平相比差异无统计学意义(P>0.05),治疗48 h后两组在上述两种炎症因子的水平与治疗前比较均明显降低(P<0.05);而且,低剂量组降低水平相比正常剂量更加明显(P<0.05)。治疗后36 h,所有纳入研究的患者中症状性颅内出血(SICH)发生5例,其中正常剂量组发生SICH人数为3例,发生率为7.14%;低剂量组SICH人数为2例,发生率为4.76%,组间比较差异无统计学意义(P>0.05)。随访后发现死亡率情况,正常剂量组中有死亡患者2例,死亡率为4.76%;低剂量组中有死亡患者2例,死亡率为4.76%,组间比较差异无统计学意义(P>0.05)。结论将低剂量阿替普酶应用于超高龄心源性脑栓塞患者,与正常剂量相比,能够得到较好的临床效果,减轻患者炎症反应,且安全性较高。
Objective To compare and analyze the efficacy and safety of standard and low dose alteplase intravenous thrombolysis that treat the elderly patients with cardiogenic cerebral embolism.Methods A prospective study method was used to select the super elderly patients with cardiogenic cerebral embolism admitted to stroke center of three hospitals in the region and divide them into low dose group and standard dose group,and compare the clinical efficacy of the two groups.Before and after treatment changes of NIHSS,mRS,FIB,PT,IL-1β,TNF-αwere compared,compare incidence of symptomatic intracranial hemorrhage 36 hours after and death rate after 90 days.Results After treatment,the number of total effective cases in the normal dose group was 30 cases,accounting for 71.43%,while the number of total effective cases in the low dose group was 40 cases,accounting for 95.24%,and had significant statistically(P<0.05).However,after treatment,NIHSS score and mRS Score were significantly decreased in both groups compared with before treatment(P<0.05),but from the point of decline,NIHSS score and mRS Score in low-dose group were significantly decreased compared with that in normal dose group(P<0.05).After 48 hours of treatment,the there are statistical significance differences between FIB level and PT of two groups(P<0.05),but there were no significant differences in FIB level and PT between the two groups after treatment(P>0.05).After 48 hours of treatment,the levels of IL-1βand TNF-αwere decreased compared before treatment significantly(P<0.05),and levels of IL-1βand TNF-αin the low-dose group after treatment were lower than normal dose group,with statistical significance(P<0.05).36 hours after treatment,5 cases of SICH occurred in all patients included in the study,including 3 cases in the normal dose group,with an incidence of 7.14%.There were 2 cases of SICH in low dose group(4.76%).There was no statistical significance between groups(P>0.05).After follow-up,there were 2 deaths in the normal dose group,the mortality rate was 4.76%,and 2 deaths in the low dose group,the mortality rate was 4.76%.There was no statistical significance between groups(P>0.05).Conclusion The low dose alteplase was applicated to the elderly patients with cardiogenic cerebral embolism,compared with the normal dose,it can be had better clinical effective,reduce inflammatory response of patients and higher safety.
作者
李莎
张燕
付胜
Li Sha;Zhang Yan;Fu Sheng(Departmen of Neurology,903 Hospital of Jiangyou,Sichuan 621700,China)
出处
《脑与神经疾病杂志》
2025年第8期511-516,共6页
Journal of Brain and Nervous Diseases
基金
绵阳市卫生健康委员会2023年科研课题(202360)。
关键词
超高龄心源性脑栓塞
低剂量阿替普酶
静脉溶栓治疗效果
安全性
Cardiogenic cerebral embolism in the elderly
Low dose alteplase
Efficacy of intravenous thrombolytic therapy
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