摘要：

目的 探讨rt-PA静脉溶栓治疗发病4.50小时内小卒中患者的有效性与安全性。方法 均为2017年7月至2018年12月住院治疗的小卒中患者共90例，分别接受rt-PA静脉溶栓（溶栓组）或常规双联抗血小板（对照组）治疗，以治疗前后美国国立卫生研究院卒中量表（NIHSS）和改良Rankin量表（mRS）评分进行疗效比较、出血性事件发生率评价静脉溶栓安全性。结果 溶栓组患者治疗后2 h（t=4.188，P=0.000）及7 d（t=4.105，P=0.000）时NIHSS评分逐渐降低，治疗有效率为60.47%（26/43），与对照组差异具有统计学意义［34.04%（16/47）；χ²=6.299，P=0.012］；两组良好结局者所占比例分别为溶栓组90.70%（39/43）、对照组65.96%（31/47），差异具有统计学意义（χ²=7.952，P=0.005）。牙龈出血（5例）为溶栓组主要并发症，与对照组大便潜血和皮下瘀斑（各1例）差异无统计学意义（Fisher确切概率法：P=0.252），均无颅内出血及死亡病例。结论 rt-PA静脉溶栓治疗发病4.50小时内的小卒中患者安全、有效，且不会增加颅内出血风险和病死率。

关键词: 卒中, 脑缺血, 血栓溶解疗法, 组织型纤溶酶原激活物

Abstract:

Objective To investigate the efficacy and safety of rt-PA in the treatment of minor stroke patients within 4.50 h of onset. Methods A total of 90 patients with minor stroke who were hospitalized in Department of Neurology from July 2017 to December 2018 were selected. They were divided into 43 cases treated with thromplysis (thrombolytic group) and 47 cases with routine antiplatet drugs (control group). Results National Institutes of Health Stroke Scale (NIHSS) gradually decrease during 2 h and 7 d after treatment of thrombolysis. The effective percentage of thrombolytic group was 60.47% (26/34), while control group was 34.04% (16/47), the diference was significant (χ²=6.299, P=0.012). The proportion of good outcome were 90.70% (39/43) in thrombolytic group and 65.96% (31/47) in control group, and the difference was significant (χ²=7.952, P=0.005). There were 5 cases of gingival bleeding in the thrombolytic group, no complications of intracranial hemorrhage and death, indicating that thrombolysis in minor stroke did not increase the risk of intracranial hemorrhage and mortality. Conclusions rt-PA intravenous thrombolysis is safe and effective for the treatment of minor stroke patients within 4.50 h of onset.

Key words: Stroke, Brain ischemia, Thrombolytic therapy, Tissue plasminogen activator