多模式核磁指導(dǎo)覺醒型卒中患者應(yīng)用rt-PA靜脈溶栓治療的有效性及安全性研究
發(fā)布時(shí)間：2019-06-29 09:27
【摘要】：目的:研究在多模式核磁指導(dǎo)下應(yīng)用重組組織型纖溶酶原激活劑(recombinant tissue plasminogen activator,rt-PA)靜脈溶栓治療覺醒型腦卒中(wake-up strokes,WUS)患者的安全性和有效性。方法:1.回顧性分析2014年12月-2016年10月天津市環(huán)湖醫(yī)院神經(jīng)內(nèi)科收治的急性腦梗死患者400例,根據(jù)能否確定患者的發(fā)病時(shí)間以及是否給予溶栓治療的具體情況進(jìn)行以下分組:(1)覺醒型卒中接受rt-PA靜脈溶栓組患者(覺醒溶栓組)128例;(2)覺醒型卒中未接受rt-PA靜脈溶栓組(覺醒非溶栓組)患者116例;(3)發(fā)病時(shí)間明確接受rt-PA靜脈溶栓組(明確發(fā)病溶栓組)156例。發(fā)病時(shí)間明確組患者發(fā)病到接受溶栓治療的時(shí)間在3h之內(nèi);覺醒溶栓組和覺醒非溶栓組的患者醒后發(fā)現(xiàn)存在神經(jīng)功能缺損癥狀與進(jìn)行治療之間的時(shí)間均在3h以內(nèi),且頭MRI均為DWI顯影而T2WI、FLAIR未顯影�；颊呷朐汉笸晟葡嚓P(guān)化驗(yàn)檢查,對(duì)符合臨床入選標(biāo)準(zhǔn)的患者給予rt-PA靜脈溶栓治療。2.記錄各組患者的年齡,性別,卒中相關(guān)危險(xiǎn)因素,并記錄實(shí)驗(yàn)室化驗(yàn)結(jié)果,各組患者入院的美國國立衛(wèi)生研究院卒中量表評(píng)分(National Institute of Health Stroke Scale,NIHSS),既往慢性疾病病史,治療后24h及治療后7d的NIHSS評(píng)分,治療90d后記錄隨訪患者的改良Rankin評(píng)分(Modified Rankin Scale,m RS),并評(píng)估各組患者治療后顱內(nèi)出血發(fā)生率和死亡率。3.預(yù)后及安全性評(píng)價(jià):預(yù)后評(píng)價(jià)包括:近期預(yù)后、遠(yuǎn)期預(yù)后。安全性評(píng)價(jià)包括:顱內(nèi)出血發(fā)生率及死亡率。結(jié)果:1.覺醒溶栓組與覺醒非溶栓組患者相比以及覺醒溶栓組與明確發(fā)病溶栓組相比,在年齡、性別、入院NIHSS評(píng)分、卒中危險(xiǎn)因素、既往慢性疾病病史、實(shí)驗(yàn)室化驗(yàn)結(jié)果等均無統(tǒng)計(jì)學(xué)差異(P0.05)。2.覺醒溶栓組與覺醒非溶栓組相比。治療24h后患者神經(jīng)功能缺損預(yù)后良好的患者覺醒溶栓組82例,占64.1%,覺醒非溶栓組45例,占38.8%,兩組之間具有顯著差異(P0.05);治療7天后患者神經(jīng)功能改善預(yù)后良好的患者覺醒溶栓組106例,占82.8%,覺醒非溶栓組73例,占62.9%,兩組之間差異明顯(P0.05)。3.3個(gè)月時(shí)遠(yuǎn)期預(yù)后良好者,覺醒溶栓組患者為111例,占86.7%,覺醒非溶栓組患者為75例,占64.7%,兩組之間存在差異(P0.05)。4.覺醒溶栓組患者非癥狀性顱內(nèi)出血發(fā)生率為1.6%,未發(fā)生癥狀性顱內(nèi)出血以及死亡患者;覺醒非溶栓組患者非癥狀性顱內(nèi)出血發(fā)生率為0.9%,死亡率為0.9%,未發(fā)生癥狀性顱內(nèi)出血患者;兩組相比較無統(tǒng)計(jì)學(xué)差異(P0.05)。5.覺醒溶栓組與明確發(fā)病溶栓組的患者相比,治療24h后患者神經(jīng)功能缺損預(yù)后良好的患者覺醒溶栓組82例,占64.1%,明確發(fā)病溶栓組102例,占65.4%,差異無統(tǒng)計(jì)學(xué)意義(P0.05);治療7天后患者神經(jīng)功能預(yù)后良好的患者覺醒溶栓組106例,占82.8%,明確發(fā)病溶栓組132例,占84.6%,無明顯差異(P0.05)。6.3個(gè)月時(shí)遠(yuǎn)期預(yù)后良好者,覺醒溶栓組患者為111例,占86.7%,明確發(fā)病溶栓組患者為136例,占87.2%,無統(tǒng)計(jì)學(xué)差異(P0.05)。7.覺醒溶栓組患者癥狀性顱內(nèi)出血發(fā)生率為0%,非癥狀性顱內(nèi)出血發(fā)生率為1.6%,死亡率為0%;明確發(fā)病溶栓組患者癥狀性顱內(nèi)出血發(fā)生率為0.6%,非癥狀性顱內(nèi)出血發(fā)生率為1.3%,死亡率為0.6%,兩組相比較無明顯差異(P0.05)。結(jié)論:1.頭顱MRI DWI-FLAIR失匹配的WUS患者行rt-PA靜脈溶栓治療是安全有效的,覺醒溶栓組與覺醒非溶栓組相比,溶栓患者的近期預(yù)后及遠(yuǎn)期預(yù)后明顯優(yōu)于非溶栓患者。2.覺醒溶栓組患者治療后癥狀性顱內(nèi)出血和非癥狀性顱內(nèi)出血發(fā)生率以及死亡率與覺醒非溶栓組之間比較無統(tǒng)計(jì)學(xué)差異。3.覺醒溶栓組患者的近期療效、遠(yuǎn)期預(yù)后及癥狀性顱內(nèi)出血和非癥狀性顱內(nèi)出血發(fā)生率以及死亡率與明確發(fā)病溶栓組患者相比差異無統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: To study the safety and efficacy of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of wake-up strokes (WUS) patients under multi-mode nuclear magnetic guidance. Method:1. A retrospective analysis of 400 patients with acute cerebral infarction from December 2014 to October 2016 in the Department of Neurology of the Huanhu Hospital, Tianjin, was analyzed retrospectively. (1) In the wake-up stroke,128 patients with the rt-PA intravenous thrombolysis group (the awakening and thrombolysis group) were received; (2)116 of the patients who had not received the rt-PA intravenous thrombolysis group (the non-thrombolytic group) were not received in the wake-up stroke; and (3)156 cases of the rt-PA venous thrombolysis group (clear-onset thrombolysis group) were clearly received in the onset time. The time of the onset of the group was within 3 hours after the onset of the thrombolytic therapy. The time between the symptoms of the neurological deficit and the treatment was found to be within 3 hours, and the head MRI was DWI and the FLAIR was not developed. After the patient was admitted to the hospital, the relevant laboratory examination was completed, and the patients who met the clinical inclusion criteria were given rt-PA intravenous thrombolysis. The age, sex, and stroke-related risk factors in each group were recorded and the laboratory test results were recorded, and the National Institute of Health Stroke Scale (NIHSS), the history of previous chronic disease,24 h after treatment, and the NIHSS score of 7 days after treatment, were recorded. The modified Rankin Scale (m RS) of the follow-up patient was recorded after 90 days of treatment and the incidence and mortality of intracranial hemorrhage after treatment in each group were assessed. Prognosis and safety evaluation: The prognosis evaluation includes the short-term prognosis and the long-term prognosis. The safety evaluation included the incidence and mortality of intracranial hemorrhage. Results:1. There was no significant difference in age, sex, admission NIHSS score, risk factor of stroke, history of previous chronic disease, laboratory test result, etc. (P0.05). The wake-up thrombolysis group was compared with that of the non-thrombolytic group. In the patients with 24-hour treatment, there were 82 patients with a good prognosis in the patients with neurological functional impairment (64.1%),45 (38.8%) in the non-thrombolytic group (38.8%), and there was a significant difference between the two groups (P <0.05). In the treatment of 7 days, the neurological function of the patients with good prognosis was 106 cases (82.8%). There were 73 cases (62.9%) in the non-thrombolytic group (62.9%), and the difference between the two groups was significant (P0.05). In 3.3 months, the long-term prognosis was good, the patients with the thrombolytic group were 111 cases (86.7%) and the non-thrombolytic group (64.7%), and there was a difference between the two groups (P0.05). The incidence of non-symptomatic intracranial hemorrhage in the awakened and thrombolytic group was 1.6%, no symptomatic intracranial hemorrhage and death; the incidence of non-symptomatic intracranial hemorrhage in the non-thrombolytic group was 0.9%, the mortality was 0.9%, and no symptomatic intracranial hemorrhage occurred; There was no statistical difference between the two groups (P0.05). There were 82 patients with a good prognosis in the treatment of the neurological deficit of the patients after 24 h compared with those of the clear-onset thrombolytic group (64.1%), and 102 cases (65.4%) of the patients with the thrombolytic group (65.4%) had no significant difference (P <0.05). After 7 days of treatment,106 cases (82.8%) and 132 (84.6%) of the patients with thrombolytic group (84.6%) had good neurological function, and there was no significant difference (P <0.05). In 6.3 months, the long-term prognosis was good, and the patients with the thrombolytic group were 111 cases (86.7%). There was no statistical difference in 87.2% (P0.05). The incidence of symptomatic intracranial hemorrhage was 0%, the incidence of non-symptomatic intracranial hemorrhage was 1.6%, and the mortality was 0%. The incidence of symptomatic intracranial hemorrhage was 0.6%, the incidence of non-symptomatic intracranial hemorrhage was 1.3%, and the mortality was 0.6%. There was no significant difference between the two groups (P0.05). Conclusion:1. The short-term prognosis and long-term prognosis of the patients with thrombolytic therapy was better than that of the non-thrombolytic group compared with the non-thrombolytic group. There was no statistical difference between the incidence of symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage, as well as between the mortality and the non-thrombolytic group. The short-term efficacy, long-term outcome, and symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage in the awake and thrombolytic group were not statistically significant as compared to those in the clear-onset thrombolytic group.
【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
本文編號(hào)：2507716
[Abstract]:Objective: To study the safety and efficacy of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of wake-up strokes (WUS) patients under multi-mode nuclear magnetic guidance. Method:1. A retrospective analysis of 400 patients with acute cerebral infarction from December 2014 to October 2016 in the Department of Neurology of the Huanhu Hospital, Tianjin, was analyzed retrospectively. (1) In the wake-up stroke,128 patients with the rt-PA intravenous thrombolysis group (the awakening and thrombolysis group) were received; (2)116 of the patients who had not received the rt-PA intravenous thrombolysis group (the non-thrombolytic group) were not received in the wake-up stroke; and (3)156 cases of the rt-PA venous thrombolysis group (clear-onset thrombolysis group) were clearly received in the onset time. The time of the onset of the group was within 3 hours after the onset of the thrombolytic therapy. The time between the symptoms of the neurological deficit and the treatment was found to be within 3 hours, and the head MRI was DWI and the FLAIR was not developed. After the patient was admitted to the hospital, the relevant laboratory examination was completed, and the patients who met the clinical inclusion criteria were given rt-PA intravenous thrombolysis. The age, sex, and stroke-related risk factors in each group were recorded and the laboratory test results were recorded, and the National Institute of Health Stroke Scale (NIHSS), the history of previous chronic disease,24 h after treatment, and the NIHSS score of 7 days after treatment, were recorded. The modified Rankin Scale (m RS) of the follow-up patient was recorded after 90 days of treatment and the incidence and mortality of intracranial hemorrhage after treatment in each group were assessed. Prognosis and safety evaluation: The prognosis evaluation includes the short-term prognosis and the long-term prognosis. The safety evaluation included the incidence and mortality of intracranial hemorrhage. Results:1. There was no significant difference in age, sex, admission NIHSS score, risk factor of stroke, history of previous chronic disease, laboratory test result, etc. (P0.05). The wake-up thrombolysis group was compared with that of the non-thrombolytic group. In the patients with 24-hour treatment, there were 82 patients with a good prognosis in the patients with neurological functional impairment (64.1%),45 (38.8%) in the non-thrombolytic group (38.8%), and there was a significant difference between the two groups (P <0.05). In the treatment of 7 days, the neurological function of the patients with good prognosis was 106 cases (82.8%). There were 73 cases (62.9%) in the non-thrombolytic group (62.9%), and the difference between the two groups was significant (P0.05). In 3.3 months, the long-term prognosis was good, the patients with the thrombolytic group were 111 cases (86.7%) and the non-thrombolytic group (64.7%), and there was a difference between the two groups (P0.05). The incidence of non-symptomatic intracranial hemorrhage in the awakened and thrombolytic group was 1.6%, no symptomatic intracranial hemorrhage and death; the incidence of non-symptomatic intracranial hemorrhage in the non-thrombolytic group was 0.9%, the mortality was 0.9%, and no symptomatic intracranial hemorrhage occurred; There was no statistical difference between the two groups (P0.05). There were 82 patients with a good prognosis in the treatment of the neurological deficit of the patients after 24 h compared with those of the clear-onset thrombolytic group (64.1%), and 102 cases (65.4%) of the patients with the thrombolytic group (65.4%) had no significant difference (P <0.05). After 7 days of treatment,106 cases (82.8%) and 132 (84.6%) of the patients with thrombolytic group (84.6%) had good neurological function, and there was no significant difference (P <0.05). In 6.3 months, the long-term prognosis was good, and the patients with the thrombolytic group were 111 cases (86.7%). There was no statistical difference in 87.2% (P0.05). The incidence of symptomatic intracranial hemorrhage was 0%, the incidence of non-symptomatic intracranial hemorrhage was 1.6%, and the mortality was 0%. The incidence of symptomatic intracranial hemorrhage was 0.6%, the incidence of non-symptomatic intracranial hemorrhage was 1.3%, and the mortality was 0.6%. There was no significant difference between the two groups (P0.05). Conclusion:1. The short-term prognosis and long-term prognosis of the patients with thrombolytic therapy was better than that of the non-thrombolytic group compared with the non-thrombolytic group. There was no statistical difference between the incidence of symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage, as well as between the mortality and the non-thrombolytic group. The short-term efficacy, long-term outcome, and symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage in the awake and thrombolytic group were not statistically significant as compared to those in the clear-onset thrombolytic group.
【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
【參考文獻(xiàn)】
相關(guān)期刊論文 前4條
1 李雨晴;張佩蘭;;重組組織型纖溶酶原激活劑靜脈溶栓治療覺醒型卒中患者的安全性和有效性[J];實(shí)用醫(yī)學(xué)雜志;2016年22期
2 白青科;趙振國;隋海晶;謝秀海;陳娟;楊娟;周媛;;磁共振成像快速評(píng)價(jià)指導(dǎo)的覺醒型缺血性卒中患者的靜脈溶栓治療[J];中華神經(jīng)科雜志;2014年07期
3 董大偉;袁定新;王建民;辛秀峰;黃立安;徐安定;;動(dòng)脈粥樣硬化性腦梗死發(fā)病機(jī)制的特征及遠(yuǎn)期預(yù)后[J];暨南大學(xué)學(xué)報(bào)(自然科學(xué)與醫(yī)學(xué)版);2013年06期
4 畢齊;張茁;張微微;李琴;;北京等15個(gè)城市腦卒中患者院前時(shí)間及影響因素研究[J];中華流行病學(xué)雜志;2006年11期
，本文編號(hào)：2507716
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2507716.html
最近更新
教材專著
