多模式核磁指导觉醒型卒中患者应用rt-PA静脉溶栓治疗的有效性及安全性研究
发布时间：2019-06-29 09:27
【摘要】：目的:研究在多模式核磁指导下应用重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗觉醒型脑卒中(wake-up strokes,WUS)患者的安全性和有效性。方法:1.回顾性分析2014年12月-2016年10月天津市环湖医院神经内科收治的急性脑梗死患者400例,根据能否确定患者的发病时间以及是否给予溶栓治疗的具体情况进行以下分组:(1)觉醒型卒中接受rt-PA静脉溶栓组患者(觉醒溶栓组)128例;(2)觉醒型卒中未接受rt-PA静脉溶栓组(觉醒非溶栓组)患者116例;(3)发病时间明确接受rt-PA静脉溶栓组(明确发病溶栓组)156例。发病时间明确组患者发病到接受溶栓治疗的时间在3h之内;觉醒溶栓组和觉醒非溶栓组的患者醒后发现存在神经功能缺损症状与进行治疗之间的时间均在3h以内,且头MRI均为DWI显影而T2WI、FLAIR未显影。患者入院后完善相关化验检查,对符合临床入选标准的患者给予rt-PA静脉溶栓治疗。2.记录各组患者的年龄,性别,卒中相关危险因素,并记录实验室化验结果,各组患者入院的美国国立卫生研究院卒中量表评分(National Institute of Health Stroke Scale,NIHSS),既往慢性疾病病史,治疗后24h及治疗后7d的NIHSS评分,治疗90d后记录随访患者的改良Rankin评分(Modified Rankin Scale,m RS),并评估各组患者治疗后颅内出血发生率和死亡率。3.预后及安全性评价:预后评价包括:近期预后、远期预后。安全性评价包括:颅内出血发生率及死亡率。结果:1.觉醒溶栓组与觉醒非溶栓组患者相比以及觉醒溶栓组与明确发病溶栓组相比,在年龄、性别、入院NIHSS评分、卒中危险因素、既往慢性疾病病史、实验室化验结果等均无统计学差异(P0.05)。2.觉醒溶栓组与觉醒非溶栓组相比。治疗24h后患者神经功能缺损预后良好的患者觉醒溶栓组82例,占64.1%,觉醒非溶栓组45例,占38.8%,两组之间具有显著差异(P0.05);治疗7天后患者神经功能改善预后良好的患者觉醒溶栓组106例,占82.8%,觉醒非溶栓组73例,占62.9%,两组之间差异明显(P0.05)。3.3个月时远期预后良好者,觉醒溶栓组患者为111例,占86.7%,觉醒非溶栓组患者为75例,占64.7%,两组之间存在差异(P0.05)。4.觉醒溶栓组患者非症状性颅内出血发生率为1.6%,未发生症状性颅内出血以及死亡患者;觉醒非溶栓组患者非症状性颅内出血发生率为0.9%,死亡率为0.9%,未发生症状性颅内出血患者;两组相比较无统计学差异(P0.05)。5.觉醒溶栓组与明确发病溶栓组的患者相比,治疗24h后患者神经功能缺损预后良好的患者觉醒溶栓组82例,占64.1%,明确发病溶栓组102例,占65.4%,差异无统计学意义(P0.05);治疗7天后患者神经功能预后良好的患者觉醒溶栓组106例,占82.8%,明确发病溶栓组132例,占84.6%,无明显差异(P0.05)。6.3个月时远期预后良好者,觉醒溶栓组患者为111例,占86.7%,明确发病溶栓组患者为136例,占87.2%,无统计学差异(P0.05)。7.觉醒溶栓组患者症状性颅内出血发生率为0%,非症状性颅内出血发生率为1.6%,死亡率为0%;明确发病溶栓组患者症状性颅内出血发生率为0.6%,非症状性颅内出血发生率为1.3%,死亡率为0.6%,两组相比较无明显差异(P0.05)。结论:1.头颅MRI DWI-FLAIR失匹配的WUS患者行rt-PA静脉溶栓治疗是安全有效的,觉醒溶栓组与觉醒非溶栓组相比,溶栓患者的近期预后及远期预后明显优于非溶栓患者。2.觉醒溶栓组患者治疗后症状性颅内出血和非症状性颅内出血发生率以及死亡率与觉醒非溶栓组之间比较无统计学差异。3.觉醒溶栓组患者的近期疗效、远期预后及症状性颅内出血和非症状性颅内出血发生率以及死亡率与明确发病溶栓组患者相比差异无统计学意义。
[Abstract]:Objective: To study the safety and efficacy of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of wake-up strokes (WUS) patients under multi-mode nuclear magnetic guidance. Method:1. A retrospective analysis of 400 patients with acute cerebral infarction from December 2014 to October 2016 in the Department of Neurology of the Huanhu Hospital, Tianjin, was analyzed retrospectively. (1) In the wake-up stroke,128 patients with the rt-PA intravenous thrombolysis group (the awakening and thrombolysis group) were received; (2)116 of the patients who had not received the rt-PA intravenous thrombolysis group (the non-thrombolytic group) were not received in the wake-up stroke; and (3)156 cases of the rt-PA venous thrombolysis group (clear-onset thrombolysis group) were clearly received in the onset time. The time of the onset of the group was within 3 hours after the onset of the thrombolytic therapy. The time between the symptoms of the neurological deficit and the treatment was found to be within 3 hours, and the head MRI was DWI and the FLAIR was not developed. After the patient was admitted to the hospital, the relevant laboratory examination was completed, and the patients who met the clinical inclusion criteria were given rt-PA intravenous thrombolysis. The age, sex, and stroke-related risk factors in each group were recorded and the laboratory test results were recorded, and the National Institute of Health Stroke Scale (NIHSS), the history of previous chronic disease,24 h after treatment, and the NIHSS score of 7 days after treatment, were recorded. The modified Rankin Scale (m RS) of the follow-up patient was recorded after 90 days of treatment and the incidence and mortality of intracranial hemorrhage after treatment in each group were assessed. Prognosis and safety evaluation: The prognosis evaluation includes the short-term prognosis and the long-term prognosis. The safety evaluation included the incidence and mortality of intracranial hemorrhage. Results:1. There was no significant difference in age, sex, admission NIHSS score, risk factor of stroke, history of previous chronic disease, laboratory test result, etc. (P0.05). The wake-up thrombolysis group was compared with that of the non-thrombolytic group. In the patients with 24-hour treatment, there were 82 patients with a good prognosis in the patients with neurological functional impairment (64.1%),45 (38.8%) in the non-thrombolytic group (38.8%), and there was a significant difference between the two groups (P <0.05). In the treatment of 7 days, the neurological function of the patients with good prognosis was 106 cases (82.8%). There were 73 cases (62.9%) in the non-thrombolytic group (62.9%), and the difference between the two groups was significant (P0.05). In 3.3 months, the long-term prognosis was good, the patients with the thrombolytic group were 111 cases (86.7%) and the non-thrombolytic group (64.7%), and there was a difference between the two groups (P0.05). The incidence of non-symptomatic intracranial hemorrhage in the awakened and thrombolytic group was 1.6%, no symptomatic intracranial hemorrhage and death; the incidence of non-symptomatic intracranial hemorrhage in the non-thrombolytic group was 0.9%, the mortality was 0.9%, and no symptomatic intracranial hemorrhage occurred; There was no statistical difference between the two groups (P0.05). There were 82 patients with a good prognosis in the treatment of the neurological deficit of the patients after 24 h compared with those of the clear-onset thrombolytic group (64.1%), and 102 cases (65.4%) of the patients with the thrombolytic group (65.4%) had no significant difference (P <0.05). After 7 days of treatment,106 cases (82.8%) and 132 (84.6%) of the patients with thrombolytic group (84.6%) had good neurological function, and there was no significant difference (P <0.05). In 6.3 months, the long-term prognosis was good, and the patients with the thrombolytic group were 111 cases (86.7%). There was no statistical difference in 87.2% (P0.05). The incidence of symptomatic intracranial hemorrhage was 0%, the incidence of non-symptomatic intracranial hemorrhage was 1.6%, and the mortality was 0%. The incidence of symptomatic intracranial hemorrhage was 0.6%, the incidence of non-symptomatic intracranial hemorrhage was 1.3%, and the mortality was 0.6%. There was no significant difference between the two groups (P0.05). Conclusion:1. The short-term prognosis and long-term prognosis of the patients with thrombolytic therapy was better than that of the non-thrombolytic group compared with the non-thrombolytic group. There was no statistical difference between the incidence of symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage, as well as between the mortality and the non-thrombolytic group. The short-term efficacy, long-term outcome, and symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage in the awake and thrombolytic group were not statistically significant as compared to those in the clear-onset thrombolytic group.
【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
本文编号：2507716
[Abstract]:Objective: To study the safety and efficacy of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of wake-up strokes (WUS) patients under multi-mode nuclear magnetic guidance. Method:1. A retrospective analysis of 400 patients with acute cerebral infarction from December 2014 to October 2016 in the Department of Neurology of the Huanhu Hospital, Tianjin, was analyzed retrospectively. (1) In the wake-up stroke,128 patients with the rt-PA intravenous thrombolysis group (the awakening and thrombolysis group) were received; (2)116 of the patients who had not received the rt-PA intravenous thrombolysis group (the non-thrombolytic group) were not received in the wake-up stroke; and (3)156 cases of the rt-PA venous thrombolysis group (clear-onset thrombolysis group) were clearly received in the onset time. The time of the onset of the group was within 3 hours after the onset of the thrombolytic therapy. The time between the symptoms of the neurological deficit and the treatment was found to be within 3 hours, and the head MRI was DWI and the FLAIR was not developed. After the patient was admitted to the hospital, the relevant laboratory examination was completed, and the patients who met the clinical inclusion criteria were given rt-PA intravenous thrombolysis. The age, sex, and stroke-related risk factors in each group were recorded and the laboratory test results were recorded, and the National Institute of Health Stroke Scale (NIHSS), the history of previous chronic disease,24 h after treatment, and the NIHSS score of 7 days after treatment, were recorded. The modified Rankin Scale (m RS) of the follow-up patient was recorded after 90 days of treatment and the incidence and mortality of intracranial hemorrhage after treatment in each group were assessed. Prognosis and safety evaluation: The prognosis evaluation includes the short-term prognosis and the long-term prognosis. The safety evaluation included the incidence and mortality of intracranial hemorrhage. Results:1. There was no significant difference in age, sex, admission NIHSS score, risk factor of stroke, history of previous chronic disease, laboratory test result, etc. (P0.05). The wake-up thrombolysis group was compared with that of the non-thrombolytic group. In the patients with 24-hour treatment, there were 82 patients with a good prognosis in the patients with neurological functional impairment (64.1%),45 (38.8%) in the non-thrombolytic group (38.8%), and there was a significant difference between the two groups (P <0.05). In the treatment of 7 days, the neurological function of the patients with good prognosis was 106 cases (82.8%). There were 73 cases (62.9%) in the non-thrombolytic group (62.9%), and the difference between the two groups was significant (P0.05). In 3.3 months, the long-term prognosis was good, the patients with the thrombolytic group were 111 cases (86.7%) and the non-thrombolytic group (64.7%), and there was a difference between the two groups (P0.05). The incidence of non-symptomatic intracranial hemorrhage in the awakened and thrombolytic group was 1.6%, no symptomatic intracranial hemorrhage and death; the incidence of non-symptomatic intracranial hemorrhage in the non-thrombolytic group was 0.9%, the mortality was 0.9%, and no symptomatic intracranial hemorrhage occurred; There was no statistical difference between the two groups (P0.05). There were 82 patients with a good prognosis in the treatment of the neurological deficit of the patients after 24 h compared with those of the clear-onset thrombolytic group (64.1%), and 102 cases (65.4%) of the patients with the thrombolytic group (65.4%) had no significant difference (P <0.05). After 7 days of treatment,106 cases (82.8%) and 132 (84.6%) of the patients with thrombolytic group (84.6%) had good neurological function, and there was no significant difference (P <0.05). In 6.3 months, the long-term prognosis was good, and the patients with the thrombolytic group were 111 cases (86.7%). There was no statistical difference in 87.2% (P0.05). The incidence of symptomatic intracranial hemorrhage was 0%, the incidence of non-symptomatic intracranial hemorrhage was 1.6%, and the mortality was 0%. The incidence of symptomatic intracranial hemorrhage was 0.6%, the incidence of non-symptomatic intracranial hemorrhage was 1.3%, and the mortality was 0.6%. There was no significant difference between the two groups (P0.05). Conclusion:1. The short-term prognosis and long-term prognosis of the patients with thrombolytic therapy was better than that of the non-thrombolytic group compared with the non-thrombolytic group. There was no statistical difference between the incidence of symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage, as well as between the mortality and the non-thrombolytic group. The short-term efficacy, long-term outcome, and symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage in the awake and thrombolytic group were not statistically significant as compared to those in the clear-onset thrombolytic group.
【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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