强化他汀联合重组型组织纤溶酶原激活剂治疗急性脑梗死的疗效及安全性

发布时间：2018-04-17 21:57

  本文选题：急性脑梗死 + 强化治疗　； 参考：《中国老年学杂志》2017年15期

【摘要】：目的探讨强化他汀联合重组型组织纤溶酶原激活剂(rt-PA)治疗急性脑梗死的疗效和安全性。方法发病4.5 h内的符合溶栓治疗急性脑梗死患者,随机分为常规剂量他汀联合rt-PA溶栓组(对照组)和强化他汀联合rt-PA溶栓组(试验组);对照组溶栓后24 h开始服用阿托伐他汀(商品名立普妥,辉瑞制药公司,每粒10 mg,下同)10 mg,此后按10 mg/d剂量继续服用阿托伐他汀治疗90 d;试验组于入院后即刻予负荷剂量阿托伐他汀80 mg,此后按40 mg/d剂量继续服用阿托伐他汀治疗90 d;对照组溶栓后24 h内不予他汀治疗。所有患者均予静脉rt-PA溶栓治疗(剂量为0.6 mg/kg,最大剂量不超过90 mg),溶栓后24 h如无出血等并发症发生,可予阿司匹林100 mg/d,同时控制血压和血糖、对症治疗等药物治疗;随访主要终点指标是发病3个月临床预后[改良Rankin量表(mRS)评分];次要终点指标是溶栓后48 h早期神经功能恶化发生率和梗死体积。结果试验组治疗有效,结局良好者(mRS≤2分)61.3%;对照组治疗有效,结局良好者(mRS≤2分)48.4%,二者差异显著(P0.05)。随访观察对照组溶栓后48 h发生临床恶化6例(19.4%)明显高于试验组[3例(9.7%),P0.05]。随访观察对照组溶栓后48 h梗死体积49.2(13~119.5)ml,与试验组无明显差异[37.4(12~98.8)ml,P0.05]。至随访结束两组不良反应发生情况相似,没有因他汀类药物的不良反应而需停药者,且两组颅内出血的风险相比无明显增加。结论早期强化他汀联合rt-PA治疗可减少急性脑梗死早期神经功能恶化的发生,改善3个月时急性脑梗死患者预后,同时未见明显不良反应。
[Abstract]:Objective to evaluate the efficacy and safety of statin combined with recombinant tissue plasminogen activator (rt-PA) in the treatment of acute cerebral infarction.Methods the patients with acute cerebral infarction were treated with thrombolytic therapy within 4.5 hours.They were randomly divided into conventional statins combined with rt-PA thrombolytic group (control group) and fortified statins combined with rt-PA thrombolytic group (trial group), the control group began to take Atto vastatin 24 hours after thrombolysis (commercial name: Lipitor, Pfizer Pharmaceutical Company).Each 10 mg, 10 mg, followed by a 10 mg/d dose of Atto vastatin for 90 days; the trial group was given a loading dose of Atto vastatin 80 mg immediately after admission, followed by a 40 mg/d dose of Atto vastatin for 90 d;The patients in the radiation group were not treated with statins within 24 hours after thrombolysis.All patients were treated with intravenous rt-PA thrombolytic therapy (dose of 0.6 mg / kg, maximum dose of less than 90 mg / kg). 24 hours after thrombolysis, 100 mg / d aspirin could be given if there were no complications such as bleeding, blood pressure and blood sugar were controlled, and symptomatic treatment was given.The main end point of follow-up was the clinical prognosis of 3 months after the onset of the disease [modified Rankin scale mRSs], and the secondary endpoint was the incidence of neurologic deterioration and infarct volume 48 hours after thrombolytic therapy.Results the treatment was effective in the trial group, with Mrs 鈮，

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