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目的探讨低剂量阿替普酶(rt-pA)静脉溶栓治疗急性脑梗死的临床疗效和安全性。方法将80例急性脑梗死患者按使用rt-pA剂量不同分为2组:治疗组50例给予低剂量rt-pA(0.6mg·kg-1)静脉溶栓治疗,对照组30例给予标准剂量rt-pA(0.9mg·kg-1)治疗。对2组治疗前后神经功能进行评价,观察2组静脉溶栓治疗14d内颅内出血发生率、病死率及治疗期间并发症发生情况。溶栓治疗前及治疗后24h、14d应用美国国立卫生研究院卒中量表(NIHSS)评价神经功能,治疗后90d应用改良Rankin量表(mRS评分)评价神经功能。结果 2组治疗后NIHSS、mRS评分均较治疗前显著下降(P<0.05或P<0.01),2组各时点NIHSS、mRS评分相比差异无统计学意义(P>0.05)。治疗组治疗14d内颅内出血发生率、病死率及并发症发生率均较对照组显著降低(P<0.01)。治疗组NIHSS评分<12分患者治疗后90dmRS评分≤2分者较NIHSS评分≥12分患者显著增加(P<0.05)。结论低剂量阿替普酶静脉溶栓治疗急性脑梗死安全有效,且颅内出血和死亡事件发生率低,尤其对轻中度急性脑梗死效果好。
Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with low-dose alteplase (rt-pA) in the treatment of acute cerebral infarction. Methods Eighty patients with acute cerebral infarction were divided into two groups according to the dosage of rt-pA: 50 patients in the treatment group received low-dose rt-pA (0.6 mg · kg-1) intravenous thrombolysis and 30 patients in the control group received standard dose rt-pA (0.9 mg kg-1). The neurological function of the two groups before and after treatment was evaluated. The incidence of intracranial hemorrhage, mortality and complications during 2 days after intravenous thrombolysis in both groups were observed. Thrombolysis before and 24 h, 14 d after treatment with the National Institutes of Health Stroke Scale (NIHSS) evaluation of neurological function 90 days after treatment with modified Rankin scale (mRS score) evaluation of neurological function. Results The scores of NIHSS and mRS in both groups after treatment were significantly lower than those before treatment (P <0.05 or P <0.01). There was no significant difference in NIHSS and mRS scores between the two groups at each time point (P> 0.05). The incidence of intracranial hemorrhage, the morbidity rate and the complication rate of the treatment group within 14 days after treatment were significantly lower than those of the control group (P <0.01). Patients in the treatment group with NIHSS score <12 had a significantly higher score (P <0.05) than those with NIHSS score ≥12 in 90dmRS score ≤2 after treatment. Conclusion Low-dose intravenous infusion of alteplase for acute cerebral infarction is safe and effective, and the incidence of intracranial hemorrhage and death is low, especially for mild to moderate acute cerebral infarction.