| 张玉敏,孙继兴,周琪,等.阿替普酶静脉溶栓治疗不同TOAST分型急性脑梗死的疗效观察[J].安徽医药,2018,22(12):2423-2426. |
| 阿替普酶静脉溶栓治疗不同TOAST分型急性脑梗死的疗效观察 |
| Observation on the efficacy of intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction with different TOAST classification |
| 投稿时间：2017-02-20 |
| DOI： |
| 中文关键词: 急性脑梗死 TOAST分型 阿替普酶 NIHSS评分 改良Rankin评分(mRS评分) |
| 英文关键词: Acute cerebral infarction TOAST types rt-PA NIHSS mRS |
| 基金项目:河北省医学科学研究重点课题(20171295) |
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| 中文摘要: |
| 目的 探讨阿替普酶静脉溶栓治疗对不同TOAST分型急性脑梗死疗效及预后差异,更加有效指导TOAST分型中各型脑梗死行静脉溶栓治疗方案的制定。 方法 选择2013年1月至 2015年 12 月唐山市人民医院106例急性脑梗死患者分为经阿普替酶静脉溶栓治疗组(简称溶栓组)(n=76)与未溶栓组(n=30),进一步将76例经阿替普酶静脉溶栓治疗的急性脑梗死患者按TOAST分型细分为动脉粥样硬化性卒中(LAA)型患者35例(46.0%)、腔隙性卒中或小动脉闭塞性卒中(SAO)型患者21例(27.6%)、心源性脑栓塞(CE)型患者10例(13.2%)、其他罕见的原因导致的缺血性卒中(SOE)+不明原因的缺血性卒中(SUE)型患者10例(13.2%),分别比较溶栓组与未溶栓组、不同TOAST分型脑梗死溶栓组间治疗前、治疗后24 h、14 d、30 d、90 d的NIHSS评分及溶栓治疗前、治疗后90 d的改良Rankin评分(mRS评分)。 结果 急性脑梗死溶栓组与未溶栓组两组治疗前NIHSS和mRS评分差异无统计学意义(P＞0.05),溶栓组治疗后24 h、14 d、30 d、90 d的NIHSS评分和90 d mRS与未溶栓组的指标进行比较,均差异有统计学意义(P＜0.05)。不同TOAST分型脑梗死溶栓治疗后NIHSS和mRS评分均有改善。治疗前SAO型NIHSS评分与CE型的NIHSS评分比较,差异有统计学意义(P＜0.05)；治疗后24 h、14 d、30 d、90 d的NIHSS评分SAO型分别与LAA型、CE型比较,差异有统计学意义(P＜0.05)； SAO型治疗前及治疗后90 d mRS评分与CE型mRS评分比较,差异有统计学意义(P＜0.05)。 结论 不同TOAST分型急性脑梗死行阿替普酶静脉溶栓治疗后神经功能缺损程度均减轻,远期神经功能恢复好；且SAO型比CE型、LAA型脑梗死溶栓治疗后神经功能缺损明显减轻,远期神经功能恢复好。 |
| 英文摘要: |
| Objective To discuss the efficacy and prognosis of intravenous thrombolytic therapy with alteplase (rt-PA) in acute ischemic stroke cases with different levels of TOAST. Methods From January 2013 to December 2013,6 patients with acute cerebral infarction,admitted to Tangshan people′s hospital,were divided into thrombolytic group (n=76) and no thrombolysis group (n=30).76 patients,with intravenous thrombolytic therapy,were divided into four groups:LAA (35,6.0%),SAO (21,7.6%),CE (10,13.2%) and SOE+SUE (10,3.2%) group.NIHSS score was used to compare the effect among the groups,before and at 24 h,14 d,30 d,90 d after treatment.Rating of mRS was used to compare the effect before and after treatment. Results There was no significant statistical difference (P＞0.05) of NIHSS and mRS score between thrombolytic group and no thrombolysis group before treatment.However,at 14 d,30 d,90 d after treatment,NIHSS and mRS score were significantly different (P＜0.05).There was significant improvement of NIHSS and mRS score with different levels of TOAST cases.Before treatment,SAO type NIHSS score compared with CE type difference was statistically significant (P＜0.05).24 h,14 d,30 d,90 d after treatment,the NIHSS score of SAO type and LAA,CE comparative difference were significantly different (P＜0.05).The mRS score of SAO type and CE type were significantly different (P＜0.05),before and 90 d after treatment. Conclusions Different TOAST classification of acute cerebral infarction,rt-PA intravenous thrombolysis therapy,nerve function defect degree were reduced after the forward neural functional recovery.The neurologic deficits of SAO type cerebral infarction were milder than those of CE type and LAA before and after thrombolysis treatment. |
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