重组组织型纤溶酶原激活剂治疗心源性脑栓塞的临床研究.doc

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1、重组组织型纤溶酶原激活剂治疗心源性脑栓塞的临床研究张莉文何冬梅傅新民叶民徐家立张正祥陈丽华杜丽张莺芳刘新亚赵燕燕龚大伟丁新牛通讯作者1.南京明基医院神经内科江苏南京210019,南京医科大学附属医院江苏南京210000;2・南京医科大学明基神经病学研究所江苏南京210019【摘要】目的评估重组组织型纤溶酶原激活剂(rt-PA)治疗心源性脑栓塞的有效性和安全性•方法采用回顾性分析方法，选取我院心源性脑栓塞患者59例，其中溶栓组34例、非溶栓组25例.比较两组患者基线、24h、7d、90d的神经功能缺损情况、早期改善及预后良好的比例、梗死后脑出血转化的发牛率及90d患者死亡率.结果两

2、组患者基线美国国立卫牛研究院卒中量表(NIHSS)评分及改良型Rankin量表(mRS)评分差异无统计学意义.发病24h、7d后，溶栓组的NIHSS改善百分比优于非溶栓组(p=0・007和0・01).发病90d,溶栓组NIHSS预后良好百分比与非溶栓组比较，差异无统计学意义(p=1・00).溶栓组24h出血转化情况较非溶栓组严重(p=0.04),7d出血转化情况与非溶栓组比较差异无统计学意义(p=0・57).发病90d,溶栓组与非溶栓组患者死亡例数分别为11例和10例，差异无统计学意义(p=0・54).结论:rt—PA用于治疗心源性脑栓塞能够提高早期改善百分比，但同时会增加早期出

3、血转化风险;在远期预后、总体出血转化及死亡情况方面与常规抗凝治疗无明显差异.【关键词】重组组织型纤溶酶原激活剂；心源性脑栓塞；溶栓；出血转化[Abstract]Objective:Toevaluatetheeffectivenessandsafetyofintravenousrecombinanttissueplasminogenactivator(rt—PA)incardiogeniccerebralemGbolism.Methods:Werespectivelyreviewedthepatientswithcardiogeniccerebralembolisminourhos

4、pital.Fifty—ninesubjectswereenrolledandthirty—fourofthemwerethrombolyticgroupandtheothertwenty—fivepatientswerenon—thrombolyticgroup.Theneurologicaldeficits,andtheincidenceoffavorableoutGcomeonthebaseline*24thhouc7thdayand90thdaywerecompared.Theincidenceofhemorrhagictransformation(HT)andmorta

5、litywithin90dayswereanGalyzed.Results:TherewasnosignificantdifferenceintheNationallnstitutesofHealthStrokeScale(NIHSS)scoreandModifiedRankinScale(mRS)intheonGset,24thhour,7thday,and90thdaybetweenbothgroups.However;theincidenceofearlyimprovementinthethrombolyticgroupsignificantlyincreasedcomGp

6、aredwiththenon—thrombolyticgroup(p=0・007和0.01).At90thday,theincidenceofgoodprognosisinthethrombolyticgroupisnosignificantincreasecomGparedwiththenon—thrombolyticgroup(p=1.00).TheincidenceofHTat24thhourwassignificantly(p=0.04)higherinthethrombolyticgroupthanthatinthenon—thrombolyticgroup,butth

7、edifferencebecamenotsign讦icantat7thday(p=0.57).Therewere11and10deathcasesinthethrombolyticandnonthrombolyticgroupswithin90daysfromtheonset,respectively,andnosignificantdifferencewasobserved(p=0.54).Conclusion:Thert—PAincreasedtheinGcidenceofe