基层医院阿替普酶治疗急性脑梗死回顾性分析

发布时间：2018-02-10 02:50

本文关键词： 急性脑梗死阿替普酶静脉溶栓基层医院　出处：《广东医学》2017年03期 　论文类型：期刊论文

【摘要】：目的回顾性分析阿替普酶治疗急性脑梗死患者时间窗内溶栓和非溶栓人群的情况。方法收治发病在0~4.5 h内急性脑梗死患者共279例,其中175例接受了阿替普酶溶栓治疗(溶栓组),104例拒绝溶栓治疗(非溶栓组)。分析两组患者在入院时、入院24 h、7 d NIHSS评分、24 h内出血风险,主要考量的临床结果为90d mRS评分,定义0~1分为预后良好。结果时间窗内接受溶栓的比例为62.7%。65%的溶栓患者DNT时间控制在60 min内,在90 d mRS评分中,溶栓组获得良好预后的比例要大于非溶栓组,OR值为1.776(95%可信区间为1.088~2.901)。但是24 h出血比例,溶栓组要大于非溶栓组(7.4%vs 0,P=0.002)。结论尽管使用阿替普酶溶栓会增加出血风险,但是在时间窗内的溶栓能提高急性脑梗死患者3个月的临床预后。基层医院在建立溶栓绿色通道及缩短DNT时间需要继续优化改革,普及溶栓知识、正确认识溶栓获益及风险能使更多人群接受溶栓治疗。
[Abstract]:Objective to retrospectively analyze the situation of patients with acute cerebral infarction treated with atropase in time window and non-thrombolytic group. Methods 279 patients with acute cerebral infarction within 4.5 hours after acute cerebral infarction were treated. One hundred and seventy-five patients were treated with Atiplase thrombolytic therapy (non-thrombolytic group, 104 patients with thrombolytic therapy group). The risk of hemorrhage was analyzed in the two groups at 24 h and 7 d after admission. The main clinical results were 90 d mRS score. Results the proportion of patients receiving thrombolytic therapy in the time window was 62.7.65%. The DNT time of thrombolytic patients was controlled within 60 min and 90 days mRS score. The odds ratio of good prognosis in the thrombolytic group was higher than that in the non-thrombolytic group (OR = 1.776 ~ 95% CI = 1.088 卤2.901g), but the bleeding rate in the thrombolytic group was higher than that in the non-thrombolytic group (P = 7.4 vs 0 P 0.002). However, thrombolytic therapy in time window can improve the clinical prognosis of patients with acute cerebral infarction in 3 months. In establishing green channel of thrombolytic therapy and shortening the time of DNT, primary hospitals should continue to optimize the reform and popularize the knowledge of thrombolytic therapy. A correct understanding of the benefits and risks of thrombolytic therapy will enable more people to receive thrombolytic therapy.
【作者单位】：博罗县人民医院神经内科(卒中中心);
【分类号】：R743.33

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