摘要
目的探讨阿替普酶静脉溶栓(IVT)联合血管内治疗(EVT)对急诊重症缺血性脑卒中患者的治疗效果及安全性。方法80例急诊重症缺血性脑卒中患者,随机分为对照组(n=40,单纯药物保守治疗)及观察组(n=40,在对照组基础上行阿替普酶IVT联合EVT)。对比两组血管再通率、美国国立卫生研究院卒中量表(NIHSS)评分、血小板计数(PLT)和凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(PT)]、并发症发生情况、90 d病死率。结果观察组血管再通率(85.00%)较对照组(62.50%)高(P<0.05)。两组治疗前NIHSS评分对比无明显差异(P>0.05);观察组治疗后2 h、24 h、1周、2周及90 d的NIHSS评分分别为(10.79±3.87)、(10.59±3.76)、(7.64±3.32)、(5.26±2.43)、(2.28±0.53)分,均较对照组的(14.11±4.01)、(13.89±3.97)、(10.97±3.95)、(9.04±3.55)、(5.60±1.37)分低(P<0.05)。两组治疗前PLT、PT、APTT、FIB对比无明显差异(P>0.05);治疗后24 h,两组PLT、FIB均较治疗前下降,PT、APTT均较治疗前延长,且观察组PLT(190.77±15.43)×10^(9)/L、FIB(3.56±0.25)g/L均较对照组的(204.04±18.87)×10^(9)/L、(4.55±0.28)g/L更低,PT(12.15±1.65)s、APTT(34.66±3.82)s均较对照组的(11.11±1.04)、(26.51±3.62)s更长(P<0.05)。观察组并发症发生率、90 d病死率与对照组对比无明显差异(P>0.05)。结论阿替普酶IVT联合EVT可以提高急诊重症缺血性脑卒中患者的血管再通率,改善其神经功能及凝血功能,且未增加症状性颅内出血的风险,安全性可控,并可减少病死率。
Objective To explore the therapeutic effect and safety of intravenous thrombolysis(IVT)with alteplase combined with endovascular therapy(EVT)in emergency patients with severe ischemic stroke.Methods 80 emergency patients with severe ischemic stroke were randomly divided into a control group(n=40,conservative medication alone)and an observation group(n=40,IVT with alteplase and EVT based on the control group).Comparison of the vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)score,platelet count(PLT),coagulation function indicators[activated partial thromboplastin time(APTT),fibrinogen(FIB),prothrombin time(PT)],occurrence of complications,and 90-d mortality rate between the two groups.Results The vascular recanalization rate in the observation group(85.00%)was higher than that in the control group(62.50%)(P<0.05).There was no significant difference in the NIHSS scores between the two groups before treatment(P>0.05).The NIHSS scores of the observation group at 2 h,24 h,1 week,2 weeks and 90 d after treatment were(10.79±3.87),(10.59±3.76),(7.64±3.32),(5.26±2.43),and(2.28±0.53)points,which were lower than those of the control group[(14.11±4.01),(13.89±3.97),(10.97±3.95),(9.04±3.55),and(5.60±1.37)points](P<0.05).There was no significant difference in PLT,PT,APTT and FIB between the two groups before treatment(P>0.05).At 24 h after treatment,the PLT and FIB in both groups decreased compared with those before treatment,and the PT and APTT were prolonged compared with those before treatment;the observation group had PLT of(190.77±15.43)×10^(9)/L and FIB of(3.56±0.25)g/L,which were lower than those in the control group[(204.04±18.87)×10^(9)/L and(26.51±3.62)g/L];the observation group had PT of(12.15±1.65)s and APTT of(34.66±3.82)s,which were longer than those in the control group[(11.11±1.04)and(26.51±3.62)s](P<0.05).There was no significant difference in the incidence of complications and 90-d mortality rate between the observation group and the control group(P>0.05).Conclusion The combination of IVT with alteplase and EVT can improve the vascular recanalization rate,neurological function,and coagulation function of emergency patients with severe ischemic stroke,without increasing the risk of symptomatic intracranial hemorrhage.The safety is controllable and the mortality rate is reduced.
作者
盖斌
GAI Bin(Department of Neurology,Baoying County People's Hospital,Yangzhou 225800,China)
出处
《中国实用医药》
2025年第20期91-94,共4页
China Practical Medicine
关键词
阿替普酶
静脉溶栓
血管内治疗
重症缺血性脑卒中
神经功能
安全性
Alteplase
Intravenous thrombolysis
Endovascular therapy
Severe ischemic stroke
Neurological function
Safety
