伴未破裂颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性评价研究
发布时间：2019-01-26 21:23
【摘要】：目的评价在溶栓时间窗内,对伴未破裂颅内动脉瘤(UIAs)的急性脑梗死(ACI)患者行静脉溶栓治疗的安全性。方法选取2010年1月—2015年12月在石河子大学医学院第一附属医院神经内科卒中单元接受静脉溶栓治疗的ACI患者245例,均接受重组组织型纤溶酶原激活剂阿替普酶(rt-PA)静脉溶栓治疗。溶栓后36 h内复查颅脑CT,36 h~7 d完成颅内血管评估。根据血管评估结果,将纳入患者分为无UIAs组(n=224)和UIAs组(n=21)。记录并比较两组患者溶栓前和溶栓7 d后的美国国立卫生研究院卒中量表(NIHSS)评分、溶栓90 d后的改良Rankin量表(mRS)分级,以及溶栓后的出血情况。结果共检出伴UIAs患者21例(8.6%),UIAs 25个,直径为2.0~8.0 mm,平均直径为(4.1±1.7)mm。两组患者性别、平均年龄、吸烟率、饮酒率、合并糖尿病发生率、合并高血压发生率、合并高脂血症发生率、合并心房颤动发生率、发病至溶栓时间,溶栓前BMI、收缩压、舒张压,溶栓次日空腹血糖(FPG)、糖化血红蛋白(Hb A_(1c))、总胆固醇(TC)、三酰甘油(TG)、血小板计数、尿酸比较,差异均无统计学意义(P0.05);UIAs组患者溶栓次日低密度脂蛋白(LDL)、同型半胱氨酸低于无UIAs组,差异有统计学意义(P0.05)。溶栓前和溶栓7 d后,两组患者NIHSS评分比较,差异均无统计学意义(P0.05);溶栓7 d后两组患者NIHSS评分均低于溶栓前,差异有统计学意义(P0.05)。溶栓90 d后,两组患者mRS为0~2级发生率比较,差异无统计学意义(P0.05)。两组患者溶栓后非症状性颅内出血(N-s ICH)、症状性颅内出血(s ICH)、蛛网膜下腔出血(SHA)发生率比较,差异均无统计学意义(P0.05)。结论对伴≤8.0 mm UIAs的ACI患者行静脉溶栓治疗可能不会增加患者的动脉瘤破裂出血风险,这为静脉溶栓患者的选择和判断提供了依据,但结果仍需大样本研究的证实。
[Abstract]:Objective to evaluate the safety of intravenous thrombolysis in patients with acute cerebral infarction (ACI) with unruptured intracranial aneurysm (UIAs) in the thrombolytic time window. Methods from January 2010 to December 2015, 245 patients with ACI received intravenous thrombolytic therapy in the stroke unit of Department of Neurology, the first affiliated Hospital of Shihezi University, Medical College of Shihezi University. All patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). The evaluation of intracranial vessels was completed within 36 hours after thrombolytic therapy by reexamination of craniocerebral CT,36 hau 7 days after thrombolytic therapy. According to the results of vascular evaluation, the patients were divided into two groups: no UIAs group (n = 224) and UIAs group (n = 21). The (NIHSS) scores of stroke scale before and after thrombolytic therapy, the (mRS) grading of modified Rankin scale and bleeding after thrombolytic therapy were recorded and compared between the two groups. Results Twenty-one patients (8.6%), UIAs 25) with UIAs were found to have an average diameter of 8.0 mm, (4.1 卤1.7 mm.). Sex, average age, smoking rate, alcohol consumption rate, incidence of diabetes, hypertension, hyperlipidemia, atrial fibrillation, time from onset to thrombolysis, systolic blood pressure of BMI, before thrombolytic therapy were observed in both groups. Diastolic blood pressure, fasting blood glucose (FPG), glycosylated hemoglobin (Hb A1c), total cholesterol (TC), triacylglycerol (TG), platelet count, uric acid) had no significant difference (P0.05). The low density lipoprotein (LDL) (LDL), homocysteine level in UIAs group was significantly lower than that in no UIAs group on the day after thrombolysis (P0.05). Before and 7 days after thrombolysis, there was no significant difference in NIHSS scores between the two groups (P0.05); after 7 days of thrombolysis, the NIHSS scores of the two groups were lower than those before thrombolysis (P0.05). After 90 days of thrombolytic therapy, there was no significant difference in the incidence of mRS between the two groups (P 0.05). There was no significant difference in the incidence of (SHA) between the two groups after thrombolytic non-symptomatic intracranial hemorrhage (N-s ICH), symptomatic intracranial hemorrhage, (s ICH), subarachnoid hemorrhage) (P0.05). Conclusion intravenous thrombolytic therapy for patients with ACI 鈮，
本文编号：2415922
[Abstract]:Objective to evaluate the safety of intravenous thrombolysis in patients with acute cerebral infarction (ACI) with unruptured intracranial aneurysm (UIAs) in the thrombolytic time window. Methods from January 2010 to December 2015, 245 patients with ACI received intravenous thrombolytic therapy in the stroke unit of Department of Neurology, the first affiliated Hospital of Shihezi University, Medical College of Shihezi University. All patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). The evaluation of intracranial vessels was completed within 36 hours after thrombolytic therapy by reexamination of craniocerebral CT,36 hau 7 days after thrombolytic therapy. According to the results of vascular evaluation, the patients were divided into two groups: no UIAs group (n = 224) and UIAs group (n = 21). The (NIHSS) scores of stroke scale before and after thrombolytic therapy, the (mRS) grading of modified Rankin scale and bleeding after thrombolytic therapy were recorded and compared between the two groups. Results Twenty-one patients (8.6%), UIAs 25) with UIAs were found to have an average diameter of 8.0 mm, (4.1 卤1.7 mm.). Sex, average age, smoking rate, alcohol consumption rate, incidence of diabetes, hypertension, hyperlipidemia, atrial fibrillation, time from onset to thrombolysis, systolic blood pressure of BMI, before thrombolytic therapy were observed in both groups. Diastolic blood pressure, fasting blood glucose (FPG), glycosylated hemoglobin (Hb A1c), total cholesterol (TC), triacylglycerol (TG), platelet count, uric acid) had no significant difference (P0.05). The low density lipoprotein (LDL) (LDL), homocysteine level in UIAs group was significantly lower than that in no UIAs group on the day after thrombolysis (P0.05). Before and 7 days after thrombolysis, there was no significant difference in NIHSS scores between the two groups (P0.05); after 7 days of thrombolysis, the NIHSS scores of the two groups were lower than those before thrombolysis (P0.05). After 90 days of thrombolytic therapy, there was no significant difference in the incidence of mRS between the two groups (P 0.05). There was no significant difference in the incidence of (SHA) between the two groups after thrombolytic non-symptomatic intracranial hemorrhage (N-s ICH), symptomatic intracranial hemorrhage, (s ICH), subarachnoid hemorrhage) (P0.05). Conclusion intravenous thrombolytic therapy for patients with ACI 鈮，
本文编号：2415922
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2415922.html
最近更新
教材专著
