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目的观察重组组织型纤溶酶原激活剂(rt-PA)早期静脉溶栓治疗急性脑梗死的疗效及安全性。方法25例发病时间<3h的急性脑梗死患者接受rt-PA静脉溶栓治疗,剂量(0.6～0.9)mg/kg。溶栓前及溶栓后2h、24h及7d接受美国国立卫生院卒中量表(NIHSS)评分,3个月接受改良Rankin评分,并观察安全性。结果溶栓后7d的NIHSS评分较基线值显著改善(P=0.04),20例完成3个月MRS评估者中,0～1分6例(30%),死亡2例(10%)。症状性脑出血患者2例。基线NIHSS评分高(P=0.002)及完全前循环梗死型(P=0.01)者易发生症状性脑出血。结论早期静脉溶栓治疗急性脑梗死能改善患者的远期预后。
Objective To observe the efficacy and safety of early intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction. Methods 25 patients with onset of acute cerebral infarction <3h received rt-PA intravenous thrombolysis at a dose of 0.6-0.9 mg / kg. The National Institutes of Health Stroke Scale (NIHSS) score was administered before thrombolysis and at 2h, 24h and 7d after thrombolysis and improved Rankin score at 3 months. Safety was also observed. Results The NIHSS score at 7 days after thrombolysis was significantly improved from baseline (P = 0.04). Among the 20 patients who completed 3 months of MRS evaluation, 6 patients (30%) were 0 to 1 and 2 patients died (10%). Symptomatic intracerebral hemorrhage in 2 patients. Symptomatic intracerebral hemorrhage is most likely to occur in patients with a high baseline NIHSS score (P = 0.002) and complete anterior circulation infarction (P = 0.01). Conclusion Early intravenous thrombolysis in patients with acute cerebral infarction can improve the long-term prognosis of patients.