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目的:观察阿替普酶(alteplase,rt-PA)在脑梗死4.5 h内溶栓的有效性及安全性,分析影响静脉溶栓预后因素。方法:回顾2007-2012年台州一院和温州一院96例4.5 h内静脉溶栓患者的资料,以NINDS研究和ECASS-3研究的资料作为本研究的对照。结果:对比经典试验,有统计学差异表明溶栓改善近期及长期预后,24 h改善率达52.1%,3个月预后良好的比例为46.9%,虽然增加了颅内出血风险,但以非症状性颅内出血为主,且不增加总体死亡率。良好预后与基线NIHSS评分≤12和24 h改善率相关。结论:只要严格掌握了溶栓的适应症和禁忌症,阿替普酶4.5 h内静脉溶栓是有效且安全的,特别是轻、中度(NIHSS≤12)卒中患者获益最大;可明显改善脑梗死患者的预后;不良预后与基线卒中病情严重相关。
Objective: To observe the effectiveness and safety of alteplase (rt-PA) in thrombolytic therapy within 4.5 hours of cerebral infarction and to analyze the prognostic factors of thrombolytic therapy. Methods: The data of 96 patients with intravenous thrombolysis within 96 h in Taizhou First Hospital and Wenzhou First Hospital from 2007 to 2012 were retrospectively analyzed. The data of NINDS and ECASS-3 were used as the control in this study. Results: Compared with the classic test, there was a statistically significant difference between the two groups. The thrombolysis improved the short-term and long-term prognosis. The improvement rate was 52.1% at 24 h and 46.9% at 3 months. Although the intracranial hemorrhage was increased, Intracranial hemorrhage, without increasing the overall mortality. Good prognosis correlated with baseline NIHSS scores ≤12 and 24 h improvement. CONCLUSIONS: Intravenous thrombolytic therapy with intrapulmonary 4.5-h alteplase is effective and safe as long as strict indications and contraindications to thrombolytic therapy are obtained. In particular, patients with mild to moderate stroke (NIHSS ≤ 12) benefit most Improve the prognosis of patients with cerebral infarction; poor prognosis and the severity of the baseline stroke are seriously related.