本文選題：急性腦梗死 + 強(qiáng)化治療　； 參考：《中國老年學(xué)雜志》2017年15期

【摘要】：目的探討強(qiáng)化他汀聯(lián)合重組型組織纖溶酶原激活劑(rt-PA)治療急性腦梗死的療效和安全性。方法發(fā)病4.5 h內(nèi)的符合溶栓治療急性腦梗死患者,隨機(jī)分為常規(guī)劑量他汀聯(lián)合rt-PA溶栓組(對(duì)照組)和強(qiáng)化他汀聯(lián)合rt-PA溶栓組(試驗(yàn)組);對(duì)照組溶栓后24 h開始服用阿托伐他汀(商品名立普妥,輝瑞制藥公司,每粒10 mg,下同)10 mg,此后按10 mg/d劑量繼續(xù)服用阿托伐他汀治療90 d;試驗(yàn)組于入院后即刻予負(fù)荷劑量阿托伐他汀80 mg,此后按40 mg/d劑量繼續(xù)服用阿托伐他汀治療90 d;對(duì)照組溶栓后24 h內(nèi)不予他汀治療。所有患者均予靜脈rt-PA溶栓治療(劑量為0.6 mg/kg,最大劑量不超過90 mg),溶栓后24 h如無出血等并發(fā)癥發(fā)生,可予阿司匹林100 mg/d,同時(shí)控制血壓和血糖、對(duì)癥治療等藥物治療;隨訪主要終點(diǎn)指標(biāo)是發(fā)病3個(gè)月臨床預(yù)后[改良Rankin量表(mRS)評(píng)分];次要終點(diǎn)指標(biāo)是溶栓后48 h早期神經(jīng)功能惡化發(fā)生率和梗死體積。結(jié)果試驗(yàn)組治療有效,結(jié)局良好者(mRS≤2分)61.3%;對(duì)照組治療有效,結(jié)局良好者(mRS≤2分)48.4%,二者差異顯著(P0.05)。隨訪觀察對(duì)照組溶栓后48 h發(fā)生臨床惡化6例(19.4%)明顯高于試驗(yàn)組[3例(9.7%),P0.05]。隨訪觀察對(duì)照組溶栓后48 h梗死體積49.2(13~119.5)ml,與試驗(yàn)組無明顯差異[37.4(12~98.8)ml,P0.05]。至隨訪結(jié)束兩組不良反應(yīng)發(fā)生情況相似,沒有因他汀類藥物的不良反應(yīng)而需停藥者,且兩組顱內(nèi)出血的風(fēng)險(xiǎn)相比無明顯增加。結(jié)論早期強(qiáng)化他汀聯(lián)合rt-PA治療可減少急性腦梗死早期神經(jīng)功能惡化的發(fā)生,改善3個(gè)月時(shí)急性腦梗死患者預(yù)后,同時(shí)未見明顯不良反應(yīng)。
[Abstract]:Objective to evaluate the efficacy and safety of statin combined with recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction.Methods the patients with acute cerebral infarction were treated with thrombolytic therapy within 4.5 hours.They were randomly divided into conventional statins combined with rt-PA thrombolytic group (control group) and fortified statins combined with rt-PA thrombolytic group (trial group), the control group began to take Atto vastatin 24 hours after thrombolysis (commercial name: Lipitor, Pfizer Pharmaceutical Company).Each 10 mg, 10 mg, followed by a 10 mg/d dose of Atto vastatin for 90 days; the trial group was given a loading dose of Atto vastatin 80 mg immediately after admission, followed by a 40 mg/d dose of Atto vastatin for 90 d;The patients in the radiation group were not treated with statins within 24 hours after thrombolysis.All patients were treated with intravenous rt-PA thrombolytic therapy (dose of 0.6 mg / kg, maximum dose of less than 90 mg / kg). 24 hours after thrombolysis, 100 mg / d aspirin could be given if there were no complications such as bleeding, blood pressure and blood sugar were controlled, and symptomatic treatment was given.The main end point of follow-up was the clinical prognosis of 3 months after the onset of the disease [modified Rankin scale mRSs], and the secondary endpoint was the incidence of neurologic deterioration and infarct volume 48 hours after thrombolytic therapy.Results the treatment was effective in the trial group, with Mrs 鈮，

本文編號(hào)：1765453