【摘要】：目的:了解急性缺血性腦卒中患者中80歲以上高齡患者應(yīng)用阿替普酶靜脈溶栓的有效性和安全性。方法:1.收集天津市環(huán)湖醫(yī)院神經(jīng)內(nèi)科收治的從2014年7月至2016年12月的急性缺血性卒中患者274例,用藥均在起病4.5小時(shí)內(nèi),年齡在60-89歲之間,其中184例接受rt-PA靜脈溶栓治療,并根據(jù)年齡分兩組,低齡老年溶栓組96例,年齡在60-79歲,給予rt-PA靜脈溶栓治療;高齡老年溶栓組88例,80-89歲,給予rt-PA靜脈溶栓治療;高齡老年非溶栓組90例,80-89歲,給予阿司匹林腸溶片口服抗血小板聚集治療,不給予rt-PA靜脈溶栓。2.研究分析入選患者的性別、年齡、危險(xiǎn)因素、合并高血壓、合并糖尿病、合并冠心病、合并高脂血癥、合并冠心病、合并房顫等,溶栓治療后24小時(shí)美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分改善情況、溶栓后24小時(shí)出血轉(zhuǎn)化率、溶栓后24小時(shí)癥狀性出血轉(zhuǎn)化率。比較溶栓后的治療有效率、病情惡化率和出血轉(zhuǎn)化率。結(jié)果:1.三組老年患者在基線資料上比較,在危險(xiǎn)因素上,如高血壓、糖尿病、高脂血癥、吸煙、肥胖等,在性別、入院時(shí)血壓和血糖、基線NIHSS評(píng)分等無明顯差異;高齡老年溶栓組和高齡老年非溶栓組在年齡上差異無統(tǒng)計(jì)學(xué)意義;高齡老年組合并冠狀動(dòng)脈粥樣硬化性心臟病者和合并房顫者高于低齡老年組,差異有統(tǒng)計(jì)學(xué)意義。2.高齡老年溶栓組治療有效例數(shù)為31例(35.2%),高齡老年非溶栓組治療有效例數(shù)為2例(2.2%),兩組比較差異有統(tǒng)計(jì)學(xué)意義。高齡老年溶栓組與高齡老年非溶栓組組治療有效率存在顯著差異。3.高齡老年溶栓組病情惡化為3例(3.4%),低齡老年溶栓組病情惡化為4例(4.2%),兩組比較差異無統(tǒng)計(jì)學(xué)意義。高齡老年溶栓組與低齡老年溶栓組比較,病情惡化無明顯差異。4.高齡老年溶栓組發(fā)生顱內(nèi)出血轉(zhuǎn)化的有2例(2.3%),低齡老年溶栓組發(fā)生顱內(nèi)出血轉(zhuǎn)化的有3例(3.1%),兩組比較差異無統(tǒng)計(jì)學(xué)意義。高齡老年溶栓組發(fā)生癥狀性顱內(nèi)出血的有0例,低齡老年溶栓組發(fā)生癥狀性顱內(nèi)出血的有1例(1.0%),兩組比較差異無統(tǒng)計(jì)學(xué)意義。高齡老年溶栓組發(fā)生非癥狀性顱內(nèi)出血的有2例(2.3%),低齡老年溶栓組發(fā)生非癥狀性顱內(nèi)出血的有2例(2.1%),差異無統(tǒng)計(jì)學(xué)意義。高齡老年溶栓組與低齡老年溶栓組在發(fā)生顱內(nèi)出血轉(zhuǎn)化、癥狀性顱內(nèi)出血和非癥狀性顱內(nèi)出血等方面無明顯差異。結(jié)論:80歲以上的急性缺血性卒中患者進(jìn)行靜脈溶栓是安全有效的。
[Abstract]:Objective: to investigate the efficacy and safety of intravenous thrombolytic therapy with atropine in patients over 80 years of age with acute ischemic stroke. Methods: 1. 274 patients with acute ischemic stroke from July 2014 to December 2016 were collected from Department of Neurology, Tianjin Huanhu Hospital. 184 cases received rt-PA intravenous thrombolytic therapy, and were divided into two groups according to their age. 96 cases of low age elderly thrombolytic group, aged 60-79 years, were treated with rt-PA intravenous thrombolytic therapy. 88 elderly patients (80-89 years old) were treated with rt-PA intravenous thrombolytic therapy, 90 cases of aged non-thrombolytic group (80-89 years old) received aspirin enteric-coated tablets oral antiplatelet aggregation therapy, and no intravenous thrombolytic therapy of rt-PA. 2. Sex, age, risk factors, hypertension, diabetes, coronary heart disease, hyperlipidemia, coronary heart disease, atrial fibrillation, etc. The (NIHSS) score of stroke scale was improved 24 hours after thrombolytic therapy, the conversion rate of bleeding was 24 hours after thrombolysis, and the rate of symptomatic hemorrhage was 24 hours after thrombolysis. The effective rate of treatment, the rate of deterioration and the conversion rate of bleeding after thrombolysis were compared. Results: 1. There was no significant difference in risk factors, such as hypertension, diabetes, hyperlipidemia, smoking, obesity, sex, blood pressure and blood glucose at admission, baseline NIHSS score, etc. There was no significant difference in age between the elderly thrombolytic group and the elderly non-thrombolytic group, and the difference was statistically significant in the elderly patients with coronary atherosclerotic heart disease and atrial fibrillation. 2. 2. There were 31 cases (35.2%) in elderly thrombolytic group and 2 cases (2.2%) in non-thrombolytic group. The difference between the two groups was statistically significant. The effective rate of thrombolytic therapy in the elderly group was significantly different from that in the non-thrombolytic group. There were 3 cases (3.4%) in elderly thrombolytic group and 4 cases (4.2%) in younger group. There was no significant difference between the two groups. There was no significant difference between the aged thrombolytic group and the low aged thrombolytic group. 4. Intracranial hemorrhage transformation occurred in 2 cases (2.3%) in the elderly thrombolytic group and 3 cases (3.1%) in the younger group. There was no significant difference between the two groups. There were 0 cases of symptomatic intracranial hemorrhage in the elderly thrombolytic group and 1 case (1.0%) in the younger group. There was no significant difference between the two groups. There were 2 cases (2.3%) of non-symptomatic intracranial hemorrhage in the elderly thrombolytic group and 2 cases (2.1%) in the younger group. There was no significant difference in intracranial hemorrhage transformation, symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage between the elderly and the younger. Conclusion: intravenous thrombolysis is safe and effective for patients over 80 years old with acute ischemic stroke.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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