80岁以上急性缺血性卒中患者静脉溶栓的有效性及安全性研究

发布时间：2018-12-27 10:05

【摘要】：目的:了解急性缺血性脑卒中患者中80岁以上高龄患者应用阿替普酶静脉溶栓的有效性和安全性。方法:1.收集天津市环湖医院神经内科收治的从2014年7月至2016年12月的急性缺血性卒中患者274例,用药均在起病4.5小时内,年龄在60-89岁之间,其中184例接受rt-PA静脉溶栓治疗,并根据年龄分两组,低龄老年溶栓组96例,年龄在60-79岁,给予rt-PA静脉溶栓治疗;高龄老年溶栓组88例,80-89岁,给予rt-PA静脉溶栓治疗;高龄老年非溶栓组90例,80-89岁,给予阿司匹林肠溶片口服抗血小板聚集治疗,不给予rt-PA静脉溶栓。2.研究分析入选患者的性别、年龄、危险因素、合并高血压、合并糖尿病、合并冠心病、合并高脂血症、合并冠心病、合并房颤等,溶栓治疗后24小时美国国立卫生研究院卒中量表(NIHSS)评分改善情况、溶栓后24小时出血转化率、溶栓后24小时症状性出血转化率。比较溶栓后的治疗有效率、病情恶化率和出血转化率。结果:1.三组老年患者在基线资料上比较,在危险因素上,如高血压、糖尿病、高脂血症、吸烟、肥胖等,在性别、入院时血压和血糖、基线NIHSS评分等无明显差异;高龄老年溶栓组和高龄老年非溶栓组在年龄上差异无统计学意义;高龄老年组合并冠状动脉粥样硬化性心脏病者和合并房颤者高于低龄老年组,差异有统计学意义。2.高龄老年溶栓组治疗有效例数为31例(35.2%),高龄老年非溶栓组治疗有效例数为2例(2.2%),两组比较差异有统计学意义。高龄老年溶栓组与高龄老年非溶栓组组治疗有效率存在显著差异。3.高龄老年溶栓组病情恶化为3例(3.4%),低龄老年溶栓组病情恶化为4例(4.2%),两组比较差异无统计学意义。高龄老年溶栓组与低龄老年溶栓组比较,病情恶化无明显差异。4.高龄老年溶栓组发生颅内出血转化的有2例(2.3%),低龄老年溶栓组发生颅内出血转化的有3例(3.1%),两组比较差异无统计学意义。高龄老年溶栓组发生症状性颅内出血的有0例,低龄老年溶栓组发生症状性颅内出血的有1例(1.0%),两组比较差异无统计学意义。高龄老年溶栓组发生非症状性颅内出血的有2例(2.3%),低龄老年溶栓组发生非症状性颅内出血的有2例(2.1%),差异无统计学意义。高龄老年溶栓组与低龄老年溶栓组在发生颅内出血转化、症状性颅内出血和非症状性颅内出血等方面无明显差异。结论:80岁以上的急性缺血性卒中患者进行静脉溶栓是安全有效的。
[Abstract]:Objective: to investigate the efficacy and safety of intravenous thrombolytic therapy with atropine in patients over 80 years of age with acute ischemic stroke. Methods: 1. 274 patients with acute ischemic stroke from July 2014 to December 2016 were collected from Department of Neurology, Tianjin Huanhu Hospital. 184 cases received rt-PA intravenous thrombolytic therapy, and were divided into two groups according to their age. 96 cases of low age elderly thrombolytic group, aged 60-79 years, were treated with rt-PA intravenous thrombolytic therapy. 88 elderly patients (80-89 years old) were treated with rt-PA intravenous thrombolytic therapy, 90 cases of aged non-thrombolytic group (80-89 years old) received aspirin enteric-coated tablets oral antiplatelet aggregation therapy, and no intravenous thrombolytic therapy of rt-PA. 2. Sex, age, risk factors, hypertension, diabetes, coronary heart disease, hyperlipidemia, coronary heart disease, atrial fibrillation, etc. The (NIHSS) score of stroke scale was improved 24 hours after thrombolytic therapy, the conversion rate of bleeding was 24 hours after thrombolysis, and the rate of symptomatic hemorrhage was 24 hours after thrombolysis. The effective rate of treatment, the rate of deterioration and the conversion rate of bleeding after thrombolysis were compared. Results: 1. There was no significant difference in risk factors, such as hypertension, diabetes, hyperlipidemia, smoking, obesity, sex, blood pressure and blood glucose at admission, baseline NIHSS score, etc. There was no significant difference in age between the elderly thrombolytic group and the elderly non-thrombolytic group, and the difference was statistically significant in the elderly patients with coronary atherosclerotic heart disease and atrial fibrillation. 2. 2. There were 31 cases (35.2%) in elderly thrombolytic group and 2 cases (2.2%) in non-thrombolytic group. The difference between the two groups was statistically significant. The effective rate of thrombolytic therapy in the elderly group was significantly different from that in the non-thrombolytic group. There were 3 cases (3.4%) in elderly thrombolytic group and 4 cases (4.2%) in younger group. There was no significant difference between the two groups. There was no significant difference between the aged thrombolytic group and the low aged thrombolytic group. 4. Intracranial hemorrhage transformation occurred in 2 cases (2.3%) in the elderly thrombolytic group and 3 cases (3.1%) in the younger group. There was no significant difference between the two groups. There were 0 cases of symptomatic intracranial hemorrhage in the elderly thrombolytic group and 1 case (1.0%) in the younger group. There was no significant difference between the two groups. There were 2 cases (2.3%) of non-symptomatic intracranial hemorrhage in the elderly thrombolytic group and 2 cases (2.1%) in the younger group. There was no significant difference in intracranial hemorrhage transformation, symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage between the elderly and the younger. Conclusion: intravenous thrombolysis is safe and effective for patients over 80 years old with acute ischemic stroke.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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