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
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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。
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 2013,106 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(35,46. 0 %),SAO(21,27. 6%),CE(10,13. 2%) and SOE + SUE(10,13. 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.
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 2013,106 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(35,46. 0 %),SAO(21,27. 6%),CE(10,13. 2%) and SOE + SUE(10,13. 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.
引文
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[13]谢江文,吕国菊,郑珍婕,等.不同年龄对阿替普酶静脉溶栓治疗急性脑梗死的临床疗效和预后的影响[J].中国临床药理学杂志,2016,32(6):486-488.
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[16]张艳丽.不同TOAST亚型的青年脑梗死患者预后的差别及影响因素[J].中国实用神经疾病杂志,2016,19(16):20-22.
[2]叶青跃,程鹏飞,周有利,等.急性脑梗死患者血小板聚集功能、血管性血友病因子、抗凝血酶及D-二聚体测定的临床意义[J].安徽医药,2015,19(2):309-311.
[3]陈晓燕,程赛宇,郭宇.阿替普酶联合肝素治疗高龄急性脑梗死患者的疗效观察[J].疑难病杂志,2012,11(9):658-660.
[4]韩晓玲.奥拉西坦联合低分子量肝素钙治疗高龄急性脑梗死的临床观察[J].临床合理用药杂志,2012,5(2):58-59.
[5]焦迎宾.早期给予阿司匹林对阿替普酶治疗的急性缺血性脑卒中患者的影响[J].中国保健营养,2012,22(8):2824.
[6]戚艳红,刘刚,沈雪,等.脑梗死血清髓鞘碱性蛋白水平与TOAST分型相关性[J].中华全科医学,2012,10(11):1672-1673,1676.
[7]王维治,罗祖明,赵忠新,等.神经病学[M]. 5版.北京:人民卫生出版社,2005:142.
[8]陆再英,钟南山.内科学[M]. 7版.北京:人民卫生出版社,2008:830-833.
[9]中华神经科学会.中华神经科学会各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[10]施彦,赖文娟,郭渊博,等. NIHSS评分在急性脑梗死患者溶栓治疗中的临床应用[J].当代医学,2013,19(35):102.
[11] MC ARTHUR K,FAN Y,PEI Z,et al. Optimising outcome assessment to improve quality and efficiency of stroke trials[J]. Expert Rev Pharmacoecon. Outcomes Res,2014,14(1):101-111.
[12]李艳萍.急诊护理路径对脑梗死溶栓治疗患者神经功能缺损及日常生活能力的影响[J].安徽医药,2014,18(7):1395-1397.
[13]谢江文,吕国菊,郑珍婕,等.不同年龄对阿替普酶静脉溶栓治疗急性脑梗死的临床疗效和预后的影响[J].中国临床药理学杂志,2016,32(6):486-488.
[14]李晓蕾,李菁晶,李轶,等.缺血性卒中A-S-C-O分型、TOAST分型及CISS分型的信度检胜[J].中国卒中杂志,2011,6(5):359-365.
[15]巩企霞,睦建,赵晶.尤瑞克林治疗不同TAOST分型急性脑梗死的临床疗效观察[J].中国医药指南,2013,11(5):5-8.
[16]张艳丽.不同TOAST亚型的青年脑梗死患者预后的差别及影响因素[J].中国实用神经疾病杂志,2016,19(16):20-22.