高龄急性轻型缺血性卒中早期阿替普酶静脉溶栓疗效观察
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摘要
目的探讨高龄轻型缺血性卒中3 h内行阿替普酶静脉溶栓治疗的疗效及安全性。方法将我院2015年10月-2017年10月连续收治入院的发病3 h内48例高龄急性轻型缺血性卒中患者随机分为阿替普酶静脉溶栓组24例和未溶栓组24例。比较两组患者入院时的一般情况,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NHISS)评分,治疗24 h后颅内出血转化率,治疗后90 d改良Rankin量表(modified Rankin Scale,m RS)评分及90 d病死率。结果阿替普酶静脉溶栓组和未溶栓组患者一般临床资料、基线NIHSS评分比较,差异无统计学意义。阿替普酶静脉溶栓组和未溶栓组治疗24 h后颅内出血转化率分别为4.17%和0(P=1.000),两组90 d病死率均为4.17%(P=1.000),阿替普酶静脉溶栓组及未溶栓组90 d m RS评分为0～2分的比率分别为83.33%和54.17%(P=0.029)。结论早期阿替普酶静脉溶栓治疗高龄急性轻型缺血性卒中不增加急性期颅内出血转化的风险,可以改善高龄轻型缺血性卒中患者预后,不增加病死率。
Objective To investigate the efficacy and safety of alteplase intravenous thrombolytic therapy within 3 hours after onset of mild ischemic stroke in the elderly.Methods In our hospital from October 2015 to October 2017,48 elderly patients with acute mild ischemic stroke who were admitted into our hospital consecutively within 3 hours after onset were randomly divided into two groups:24 patients in the intravenous thrombolysis group and 24 patients in the non-thrombolysis group.The general condition,baseline National Institute of Health Stroke Scale(NHISS) scores,intracranial hemorrhage conversion rates after 24 hours of treatment,modified Rankin Scale(m RS) score after 90 days of treatment,and 90-day mortality were compared between the two groups on admission.Results There were no significant difference in general clinical data and baseline NIHSS score between the intravenous thrombolytic group and the non-thrombolysis group.In the intravenous thrombolytic group and the non-thrombolysis group,the conversion rate of intracranial hemorrhage after 24 hours was 4.17% and 0(P=1.000).The 90-day mortality of two groups was 4.17%(P=1.000).The ratio of 90-day m RS score of 0-2 in the intravenous thrombolytic group and the non-thrombolysis group was 83.33% and 54.17%(P=0.029).Conclusion Early alteplase intravenous thrombolysis in elderly patients with acute ischemic stroke does not increase the risk of acute intracranial hemorrhage,it can significantly improve the prognosis of elderly patients with mild ischemic stroke,without increasing the mortality.
Objective To investigate the efficacy and safety of alteplase intravenous thrombolytic therapy within 3 hours after onset of mild ischemic stroke in the elderly.Methods In our hospital from October 2015 to October 2017,48 elderly patients with acute mild ischemic stroke who were admitted into our hospital consecutively within 3 hours after onset were randomly divided into two groups:24 patients in the intravenous thrombolysis group and 24 patients in the non-thrombolysis group.The general condition,baseline National Institute of Health Stroke Scale(NHISS) scores,intracranial hemorrhage conversion rates after 24 hours of treatment,modified Rankin Scale(m RS) score after 90 days of treatment,and 90-day mortality were compared between the two groups on admission.Results There were no significant difference in general clinical data and baseline NIHSS score between the intravenous thrombolytic group and the non-thrombolysis group.In the intravenous thrombolytic group and the non-thrombolysis group,the conversion rate of intracranial hemorrhage after 24 hours was 4.17% and 0(P=1.000).The 90-day mortality of two groups was 4.17%(P=1.000).The ratio of 90-day m RS score of 0-2 in the intravenous thrombolytic group and the non-thrombolysis group was 83.33% and 54.17%(P=0.029).Conclusion Early alteplase intravenous thrombolysis in elderly patients with acute ischemic stroke does not increase the risk of acute intracranial hemorrhage,it can significantly improve the prognosis of elderly patients with mild ischemic stroke,without increasing the mortality.
引文
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[12]杨建道,胡丽燕,宋彦彦,等.高龄急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓治疗的疗效及安全性分析[J].中国卒中杂志,2014,9(11):905-910.
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[16]BAUMANN C R,BAUMGARTNER R W,GANDJOUR J,et al.Good outcomes in ischemic stroke patients treated with intravenous thrombolysis despite regressing neurological symptoms[J].Stroke,2006,37(5):1332-1333.
[17]FONAROW G C,PAN W,SAVER J L,et al.Comparison of 30-day mortality models for profiling hospital performance in acute ischemic stroke with vs without adjustment for stroke severity[J].JAMA,2012,308(3):257-264.
[18]GIANTIN V,SEMPLICINI A,FRANCHIN A,et al.Outcome after acute ischemic stroke(AIS)in older patients:effects of age,neurological deficit severity and blood pressure(BP)variations[J].Arch Gerontol Geriatr,2011,52(3):185-191.
[2]LEES K R,BLUHMKI E,VON KUMMER R,et al.Time to treatment with intravenous alteplase and outcome in stroke:an updated pooled analysis of ECASS,ATLANTIS,NINDS,and EPITHET trials[J].Lancet,2010,375(9727):1695-1703.
[3]AHMED N,WAHLGREN N,GROND M,et al.Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke:an updated analysis from SITS-ISTR[J].Lancet Neurol,2010,9(9):866-874.
[4]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]FISCHER U,BAUMGARTNER A,ARNOLD M,et al.What Is a Minor Stroke?Stroke,2010,41(4):661-666.
[6]HASSAN A E,ZACHARATOS H,HASSANZADEH B,et al.Does mild deficit for patients with stroke justify the use of intravenous tissue plasminogen activator?[J].J Stroke Cerebrovasc Dis,2010,19(2):116-120.
[7]杨江胜,朱祖福,高志强,等.早期静脉溶栓治疗急性轻型缺血性卒中的疗效观察[J].临床神经病学杂志,2017,30(4):303-305.
[8]DEMAERSCHALK B M,KLEINDORFER D O,ADEOYE O M,et al.Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke:a statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2016,47(2):581-641.
[9]FURIE K L,KASNER S E,ADAMS R J,et al.Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2011,42(1):227-276.
[10]GOLDSTEIN L B,BUSHNELL C D,ADAMS R J,et al.Guidelines for the primary prevention of stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2011,42(2):517-584.
[11]IST-3 Collaborative Group,SANDERCOCK P,WARDLAW J M,et al.The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke(the third international stroke trial[IST-3]):a randomised controlled trial[J].Lancet,2012,379(9834):2352-2363.
[12]杨建道,胡丽燕,宋彦彦,等.高龄急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓治疗的疗效及安全性分析[J].中国卒中杂志,2014,9(11):905-910.
[13]HASSAN A E,HASSANZADEH B,TOHIDI V,et al.Very mild stroke patients benefit from intravenous tissue plasminogen activator without increase of intracranial hemorrhage[J].South Med J,2010,103(5):398-402.
[14]STEFFENHAGEN N,HILL M D,POPPE A Y,et al.Should you thrombolyse all or any stroke patients with baseline National Institutes of Health stroke scale scores
[16]BAUMANN C R,BAUMGARTNER R W,GANDJOUR J,et al.Good outcomes in ischemic stroke patients treated with intravenous thrombolysis despite regressing neurological symptoms[J].Stroke,2006,37(5):1332-1333.
[17]FONAROW G C,PAN W,SAVER J L,et al.Comparison of 30-day mortality models for profiling hospital performance in acute ischemic stroke with vs without adjustment for stroke severity[J].JAMA,2012,308(3):257-264.
[18]GIANTIN V,SEMPLICINI A,FRANCHIN A,et al.Outcome after acute ischemic stroke(AIS)in older patients:effects of age,neurological deficit severity and blood pressure(BP)variations[J].Arch Gerontol Geriatr,2011,52(3):185-191.