Clinical study of low-dose rt-PA combined with transcranial Doppler ultrasonography assisted intravenous thrombolysis

doi:10.3969/j.issn.1672-6731.2021.04.014

Abstract

Abstract:

Objective To investigate the efficacy and safety of low dose rt-PA combined with transcranial Doppler ultrasonography (TCD) in the intravenous thrombolysis treatment of acute ischemic stroke. Methods A total of 139 patients with acute ischemic stroke admitted to Anhui No. 2 Provincial People's Hospital from July 2016 to May 2019 were randomly divided into the rt-PA standard dose group (0.90 mg/kg, total dose ≤ 90 mg), low dose group (0.60 mg/kg, total dose ≤ 60 mg) and low dose combined with TCD group (combined treatment group). TCD was used to continuously monitor the blood flow of middle cerebral artery for 2 h at the beginning of thrombolysis in the combined treatment group. TCD was only performed before and 2 h after thrombolysis in the standard dose group and low dose group. Two hours after thrombolysis, the recanalization rates of intracranial vessels in different treatment groups were compared. National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the severity of clinical symptoms in each group, and the incidence of symptomatic intracranial hemorrhage 24-48 h after thrombolysis was recorded. The self-care ability of 90 d after thrombolytic therapy was evaluated by modified Rankin Scale (mRS), and the mortality rate was calculated. Results The recanalization rate in the combined treatment group were higher than those in the standard dose group (P=0.037) and low dose group (P=0.030), and the NIHSS score 2 h after thrombolysis was lower than that in the standard dose group (P=0.046) and low dose group (P=0.026); the incidence of symptomatic intracranial hemorrhage (P=0.017, 0.024) and 90 d mortality (P=0.005, 0.016) in the low dose group and combined treatment group were lower than those in the standard dose group. Conclusions Low dose rt-PA combined with TCD assisted intravenous thrombolysis can improve the recanalization rate without increasing the risk of symptomatic intracranial hemorrhage and death.

Key words: Stroke, Brain ischemia, Tissue plasminogen activator, Ultrasonography, Doppler, transcranial

摘要：

目的探讨低剂量rt-PA联合经颅多普勒超声（TCD）辅助静脉溶栓治疗急性缺血性卒中的疗效及安全性。方法选择2016年7月至2019年5月安徽省第二人民医院收治的139例急性缺血性卒中患者为观察对象，随机分为rt-PA标准剂量组（0.90 mg/kg，总剂量≤ 90 mg）、低剂量组（0.60 mg/kg，总剂量≤ 60 mg）和低剂量联合TCD组（联合治疗组）。联合治疗组于溶栓开始即以TCD持续监测大脑中动脉血流变化2 h，标准剂量组和低剂量组仅在溶栓治疗前与治疗后2 h行TCD检查。溶栓后2 h对不同处理组颅内血管再通率进行比较，美国国立卫生研究院卒中量表（NIHSS）评分评价各组临床症状严重程度，记录溶栓24~48 h症状性颅内出血发生率；改良Rankin量表（mRS）评价溶栓后90天生活自理能力并计算病死率。结果联合治疗组溶栓后血管再通率高于标准剂量组（P=0.037）和低剂量组（P=0.030），且溶栓后2 h NIHSS评分低于标准剂量组（P=0.046）和低剂量组（P=0.026）；低剂量组和联合治疗组症状性颅内出血发生率（P=0.017，0.024）和90 d死亡率（P=0.005，0.016）均低于标准剂量组。结论低剂量rt-PA联合TCD辅助静脉溶栓可提高患者血管再通率且不增加症状性颅内出血及死亡风险。

关键词: 卒中, 脑缺血, 组织型纤溶酶原激活物, 超声检查, 多普勒, 经颅

YUAN Chang-hong, WU Xiao-yu, CHEN Chang-chun, WANG Shu-pei, LI Xi, JIANG Yan-liu, ZHANG Lu, ZHANG Wei. Clinical study of low-dose rt-PA combined with transcranial Doppler ultrasonography assisted intravenous thrombolysis[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 317-323.

袁长红, 吴晓宇, 陈长春, 王书陪, 黎西, 江艳柳, 张璐, 张卫. 低剂量rt-PA联合经颅多普勒超声辅助静脉溶栓治疗的临床研究[J]. 中国现代神经疾病杂志, 2021, 21(4): 317-323.

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