高龄急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的疗效及安全性分析附视频

被引：28

作者：

杨建道

胡丽燕

宋彦彦

沈凌达

王少石

机构：

[1] 上海市第一人民医院分院神经内科,上海市虹口区脑血管病中心

来源：

中国卒中杂志 | 2014年 / 11期

关键词：

急性脑梗死; 高龄; 重组组织型纤溶酶原激活剂; 静脉溶栓; 出血转化;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

1002 ;

摘要：

目的探讨高龄脑梗死患者接受标准剂量重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）静脉溶栓治疗的疗效和安全性。方法对我院2011年1月2013年12月连续收治入院的254例急性脑梗死患者的临床资料进行回顾性分析,分为老龄溶栓组118例（60<年龄≤80岁,rt-PA静脉溶栓治疗）;高龄溶栓组62例（年龄>80岁,rt-PA静脉溶栓治疗）;高龄非溶栓组74例（年龄>80岁,非rt-PA静脉溶栓治疗）。比较3组入院前的一般情况,溶栓治疗前美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分,溶栓后出血转化率及治疗7 d内致死性出血率,治疗后90 d改良Rankin量表（modifed Rankin Scale,m RS）评分和90 d的病死率。结果老龄溶栓组、高龄溶栓组和高龄非溶栓组治疗前NIHSS评分（13.0±5.3、15.1±6.6、14.1±6.6;P=0.523）无显著差异,3组的急性期事件出血转化率分别为16.9%、20.9%和21.6%,P=0.675;3组7 d内致死性出血的发生率分别为3.3%,9.6%,7.4%,P=0.20。90 d内的病死率分别为11.0%,22.6%,16.2%,P=0.12。老龄溶栓组和高龄溶栓组治疗后90 d的m RS评分0～2比值分别为56.8%和38.7%,两组比值比（odds ratio,OR）为2.08;95%可信区间（confidence interval,CI）为1.11～3.86,P=0.021;两组治疗后90 d m RS评分中位数比较:2 vs 3,P=0.025。高龄溶栓组和高龄非溶栓组90 d的m RS评分0～2比值分别为38.7%和21.6%,OR 1.81,95%CI 0.80～4.06,P=0.098;90 d m RS评分中位数比较:3vs 5,P=0.008。结论与未溶栓的高龄患者相比,急性缺血性卒中老龄和高龄患者接受rt-PA治疗不增加急性期出血转化率和病死率。老龄组比高龄组rt-PA治疗获益大,高龄溶栓组比非溶栓组获益大。高龄组rt-PA治疗可以改善患者90 d生活自理能力且不增加病死率。

引用

页码：905 / 910

页数：6

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