摘要
目的观察阿替普酶静脉溶栓治疗急性脑梗死伴发心房纤颤(房颤)患者的临床疗效。方法 128例急性脑梗死患者,按是否伴发房颤情况分为房颤组(伴房颤急性脑梗死患者, 27例)和非房颤组(无房颤急性脑梗死患者, 101例)。以发病严重程度[美国国立卫生研究院卒中量表(NIHSS)评分≤10分及NIHSS评分>10分]对房颤组和非房颤组患者再进行分组。房颤组中NIHSS评分≤10分12例, NIHSS评分>10分15例。非房颤组中NIHSS评分≤10分66例, NIHSS评分>10分35例。对所有患者均进行阿替普酶静脉溶栓治疗。比较NIHSS评分≤10分、>10分房颤组与非房颤组不同时间段(溶栓前、溶栓24 h及溶栓14 d)NIHSS评分,溶栓后90 d改良RANKIN量表(mRS)评分,溶栓后出血并发症发生情况及死亡情况。结果 NIHSS评分≤10分房颤组溶栓后症状性颅内出血发生率为0(0/12),非房颤组溶栓后症状性颅内出血发生率为1.5%(1/66),比较差异无统计学意义(P>0.05);NIHSS评分>10分房颤组溶栓后症状性颅内出血发生率为20.0%(3/15),非房颤组溶栓后症状性颅内出血发生率为2.9%(1/35),两组比较差异有统计学意义(χ2=4.193, P<0.05)。NIHSS评分≤10分房颤组与非房颤组均未出现死亡患者;NIHSS评分>10分房颤组死亡率为13.3%(2/15), NIHSS评分>10分非房颤组死亡率为2.9%(1/35),比较差异无统计学意义(P>0.05)。溶栓24 h、14 d, NIHSS评分≤10分房颤组与非房颤组NIHSS评分均低于溶栓前,差异有统计学意义(P<0.05);溶栓前、溶栓24 h及溶栓14 d, NIHSS评分≤10分房颤组与非房颤组NIHSS评分比较差异均无统计学意义(P>0.05);NIHSS评分≤10分房颤组与非房颤组溶栓后90 d m RS评分比较差异无统计学意义(P>0.05)。溶栓24 h及14 d, NIHSS评分>10分房颤组NIHSS评分与溶栓前比较,差异无统计学意义(P>0.05),非房颤组NIHSS评分明显低于溶栓前,差异有统计学意义(P<0.05);溶栓24 h及14 d, NIHSS评分>10分非房颤组NIHSS评分均低于房颤组,差异有统计学意义(P<0.05);NIHSS评分>10分非房颤组溶栓后90 d mRS评分低于房颤组,差异有统计学意义(P<0.05)。结论伴发房颤的急性脑梗死症状轻的(NIHSS评分≤10分)患者应用阿替普酶静脉溶栓治疗有效,症状重的(NIHSS评分>10分)患者溶栓获益不明显。
Objective To observe the clinical efficacy of intravenous thromolysis with alteplase in the treatment of acute cerebral infarction patients with atrial fibrillation. Methods A total of 128 acute cerebral infarction patients were divided into atrial fibrillation group(with atrial fibrillation, 27 cases) and non-atrial fibrillation group(without atrial fibrillation, 101 cases) according to whether they were accompanied by atrial fibrillation. Patients in the atrial fibrillation group and the non-atrial fibrillation group were divided into subgroups according to severity of the disease [National Institutes of Health stroke scale(NIHSS) score ≤ 10 points and NIHSS score> 10 points]. In the atrial fibrillation group, NIHSS score ≤10 points in 12 patients, and NIHSS score > 10 points in 15 patients. In the non-atrial fibrillation group, NIHSS score ≤10 points in 66 cases and NIHSS score > 10 points in 35 cases. All patients were treated by intravenous thromolysis with alteplase. The NIHSS scores in different time periods(before thrombolysis, 24 h after thrombolysis and 14 d after thrombolysis), modified Rankin scale(MRS) scores at 90 d after thrombolysis and occurrence of bleeding complications and death after thrombolysis was compared between NIHSS score ≤10 points and >10 points patients in atrial fibrillation group and non-atrial fibrillation group. Results In NIHSS score ≤10 points patients, the incidence of symptomatic intracranial hemorrhage was 0(0/12) in atrial fibrillation group, which was 1.5%(1/66) in non-atrial fibrillation group, and the difference was not statistically significant(P>0.05). In NIHSS score >10 points patients, the incidence of symptomatic intracranial hemorrhage was 20.0%(3/15) in atrial fibrillation group, which was 2.9%(1/35) in non-atrial fibrillation group, and the difference was statistically significant(χ~2=4.193, P<0.05). In NIHSS score ≤10 points patients, there was no death cases in atrial fibrillation group and non-atrial fibrillation group. In NIHSS score >10 points patients, the death rate was 13.3%(2/15) in atrial fibrillation group, which was 2.9%(1/35) in non-atrial fibrillation group, and the difference was not statistically significant(P>0.05). At 24 h and 14 d after thrombolysis, NIHSS score in NIHSS score ≤10 points patients of atrial fibrillation group and nonatrial fibrillation group was lower than those before thrombolysis, and the difference was statistically significant(P<0.05). Before thrombolysis, 24 h and 14 d after thrombolysis, there was no statistically significant difference in NIHSS score in NIHSS score ≤10 points patients of atrial fibrillation group and non-atrial fibrillation group(P>0.05). At 90 d after thrombolysis, there was no statistically significant difference in m RS score in NIHSS score ≤10 points patients of atrial fibrillation group and non-atrial fibrillation group(P>0.05). At 24 h and 14 d after thrombolysis, there was no statistically significant difference in NIHSS score in NIHSS score >10 points patients of atrial fibrillation group and non-atrial fibrillation group(P>0.05). NIHSS score in non-atrial fibrillation group was obviously lower than that before thrombolysis, and the difference was statistically significant(P<0.05). At 24 h and 14 d after thrombolysis, NIHSS score in NIHSS score >10 points patients of non-atrial fibrillation group was obviously lower than that in atrial fibrillation group, and the difference was statistically significant(P<0.05). At 90 d after thrombolysis, m RS score in NIHSS score >10 points patients of non-atrial fibrillation group was lower than that in atrial fibrillation group, and the difference was statistically significant(P<0.05). Conclusion Intravenous thrombolysis with alteplase is effective for patients with mild acute cerebral infarction with atrial fibrillation(NIHSS score ≤ 10 points), and has no significant effect on patients with severe symptoms(NIHSS score > 10 points).
作者
钟思敏
钟建斌
陈炽邦
魏伟民
钟健强
张世军
余亮
ZHONG Si-min;ZHONG Jian-bin;CHEN Chi-bang(Department of Internal Medicine-Neurology,Zengcheng District People's Hospital,Guangzhou 511300,China)
出处
《中国实用医药》
2020年第2期4-7,共4页
China Practical Medicine
基金
广州市增城区人民医院青年医学人才培育基金项目(项目编号：2016-QN-04)
关键词
阿替普酶
急性脑梗死
心房纤颤
静脉溶栓
Alteplase
Acute cerebral infarction
Atrial fibrillation
Intravenous thromolysis
