Effect of low-dose recombinant tissue plasminogen activator on the prognosis in patients with cardiogenic cerebral embolism
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摘要: 目的 探讨低剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对心源性脑栓塞(CCE)患者预后和出血转化的影响。 方法 选取72例发病时间窗为4.5 h内的CCE患者作为研究对象,患者均具备溶栓指征且自愿接受rt-PA静脉溶栓治疗。采用简单随机数表法将患者分为标准剂量组(0.9 mg/kg)和低剂量组(0.6 mg/kg),每组36例。治疗后24~48 h复查颅脑CT或MRI,评估2组患者出血转化情况,比较2组溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI),并比较2组溶栓后90 d时的改良Rankin量表(mRS)评分。 结果 溶栓24 h、7 d后, 2组NIHSS评分均低于溶栓前,BI均高于溶栓前,差异有统计学意义(P<0.05); 溶栓前后, 2组NIHSS评分、BI比较,差异均无统计学意义(P>0.05); 出血转化评估结果显示, 2组颅内出血发生率、其他部位出血发生率、病死率比较,差异无统计学意义(P>0.05); 溶栓后90 d时,2组mRS评分均低于溶栓前,差异有统计学意义(P<0.05); 2组溶栓后90 d时mRS评分、预后良好率比较,差异无统计学意义(P>0.05)。 结论 CCE患者采用低剂量(0.6 mg/kg)与标准剂量(0.9 mg/kg)rt-PA静脉溶栓治疗的近期预后和出血转化风险相近,均安全有效。Abstract: Objective To investigate the effect of low-dose recombinant tissue plasminogen activator(rt-PA)on the prognosis and hemorrhagic transformation of patients with cardiogenic cerebral embolism(CCE). Methods A total of 72 CCE patients with window time of onset within 4.5 h were selected as research objects. All patients had thrombolysis indications and received rt-PA intravenous thrombolysis voluntarily. Simple random number table method was used to divide them into standard dose(0.9 mg/kg)group and low dose(0.6 mg/kg)group, with 36 cases in each group. CT at 24 to 48 hours after treatment were reexamined. The cerebral CT or MRI reexamination were performed to evaluate conditions of hemorrhagic transformation in the two groups. The scores of National Institutes of Health Stroke Scale(NIHSS)score and Barthel(BI)index between the two groups before and after treatment were compared. The modified Rankin(mRS)score of the two groups was compared at 90 days after thrombolysis. Results After 24 hours and 7 days of thrombolysis, NIHSS scores of the two groups were significantly lower than those before thrombolysis, and BI was significantly higher(P< 0.05). There was no significant differences in NIHSS score and BI between the two groups(P>0.05). There were no significant differences between the two groups in the incidence rates of intracranial hemorrhage and other bleeding sites, as well as mortality rate(P>0.05). The mRS scores at 90 days after thrombolysis in the two groups were significantly lower than that before thrombolysis(P<0.05). There were no significant differences between the two groups in mRS score- and the good rate of prognosis at 90 days after thrombolysis(P>0.05). Conclusion It is similar in short-term prognosis and the risk of bleeding transformation of CCE treated by rt-PA for intravenous thrombolysis at low dose of 0.6 mg/kg and standard dose of 0.9 mg/kg, and they are both safe and effective.
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