瑞替普酶治疗急性缺血性脑卒中临床研究

doi:10.3969/j.issn.1004-583X.2021.02.004

摘要/Abstract

摘要：

目的评价瑞替普酶在急性缺血性脑卒中溶栓治疗中的有效性及安全性。方法纳入泰安市中医院急诊科收治的急性缺血性脑卒中溶栓患者63例,随机分为瑞替普酶组和尿激酶组,比较两组溶栓前后NIHSS评分、Barthel指数、出血并发症等。结果两组治疗后较治疗前NIHSS评分改善明显,两组溶栓药物效果肯定,不同时点差异有统计学意义(P<0.05);组间及组间和不同时点的交互作用差异无统计学意义(P>0.05)。瑞替普酶组治疗后1、7、14天治疗有效率分别为64.5%、77.4%、80.6%,尿激酶组有效率分别为31.3%、46.9%、53.1%。瑞替普酶组较尿激酶组有效率更高,1、7、14天有效率比较有统计学意义。两组Bathel指数比较,瑞替普酶组患者恢复更好,致残率更低(P<0.05)。脑出血仍然是最严重的并发症,二者出血情况比较差异无统计学意义。结论瑞替普酶溶栓治疗急性缺血性脑卒中疗效肯定,能更好的改善患者的神经功能缺损,提高生存质量,且并不增加出血风险。

关键词: 卒中, 瑞替普酶, 溶栓

Abstract:

Objective To evaluate the efficacy and safety of reteplase in thrombolytic therapy for acute ischemic stroke. Methods Sixty-three patients with acute ischemic stroke admitted to Tai’an Hospital of Traditional Chinese Medicine were enrolled and randomly divided into the reteplase group and urokinase group. NIHSS scores, Barthel index and bleeding complications of patients in two groups before and after thrombolysis were compared. Results NIHSS scores of patients in two groups after treatment were improved significantly, the efficacy of thrombolytic drugs on patients in two groups was definite, and the difference was statistically significant at different time points (P<0.05). No significant differences in interactions of patients in two groups were found between groups and at different time points (P>0.05). The response rate of reteplase group on day 1, day 7 and day 14 after treatment was 64.5%, 77.4% and 80.6% respectively, and those of urokinase group were 31.3%, 46.9% and 53.1%, respectively. The response rate of reteplase group was higher than that of urokinase group, the response rate of patients on day 1, day 7 and day 14 was statistically significant. The comparison in Bathel index of patients in two groups showed that patients in the reteplase group had better recovery and lower disability rate (P<0.05). The cerebral hemorrhage remained to be the most serious complication, and comparative differences in haemorrhagic conditions of patients in two groups were not statistically significant. Conclusion Reteplase thrombolytic therapy delivers definite efficacy in treating acute ischemic stroke, can better improve neurological deficit function and improve the quality of life without increasing the bleeding risk.

Key words: stroke, reteplase, thrombolysis

中图分类号:

R743

张强, 张高兰, 刘庆东. 瑞替普酶治疗急性缺血性脑卒中临床研究[J]. 临床荟萃, 2021, 36(2): 117-120.

Zhang Qiang, Zhang Gaolan, Liu Qingdong. Clinical study on reteplase in treating acute ischemic stroke[J]. Clinical Focus, 2021, 36(2): 117-120.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.02.004

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I2/117

图/表 5

参考文献 13

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组别	例数	发病时间 (min)	糖尿病史 [例(%)]	冠心病史 [例(%)]	高血压病史 [例(%)]	高脂血症病史 [例(%)]	吸烟史 [例(%)]	饮酒史 [例(%)]
瑞替普酶组	31	154.0±52.7	5(16.1)	16(51.6)	20(64.5)	14(45.2)	13(41.9)	15(48.4)
尿激酶组	32	131.2±62.3	7(21.9)	18(56.3)	24(75.0)	11(34.4)	11(34.4)	18(56.3)
t/χ²值		1.563	0.3318	0.1341	0.8086	0.7532	0.3756	0.3841
P值		0.092	0.5646	0.7142	0.3086	0.3855	0.5400	0.5354

组别	例数	发病时间 (min)	糖尿病史 [例(%)]	冠心病史 [例(%)]	高血压病史 [例(%)]	高脂血症病史 [例(%)]	吸烟史 [例(%)]	饮酒史 [例(%)]
瑞替普酶组	31	154.0±52.7	5(16.1)	16(51.6)	20(64.5)	14(45.2)	13(41.9)	15(48.4)
尿激酶组	32	131.2±62.3	7(21.9)	18(56.3)	24(75.0)	11(34.4)	11(34.4)	18(56.3)
t/χ²值		1.563	0.3318	0.1341	0.8086	0.7532	0.3756	0.3841
P值		0.092	0.5646	0.7142	0.3086	0.3855	0.5400	0.5354

组别	例数	NIHSS评分
组别	例数	治疗前	治疗后1 d	治疗后7 d	治疗后14 d
瑞替普酶组	31	12.67±7.46	7.18±4.95^*	4.72±3.74^*	4.33±3.67^*
尿激酶组	32	12.87±7.58	9.89±5.45^*	7.96±6.14^*	6.81±5.12^*
组间		F=2.233 P=0.141
时点间		F=40.695 P=0.00
组间·时点间		F=1.968 P=0.121

组别	例数	NIHSS评分
组别	例数	治疗前	治疗后1 d	治疗后7 d	治疗后14 d
瑞替普酶组	31	12.67±7.46	7.18±4.95^*	4.72±3.74^*	4.33±3.67^*
尿激酶组	32	12.87±7.58	9.89±5.45^*	7.96±6.14^*	6.81±5.12^*
组间		F=2.233 P=0.141
时点间		F=40.695 P=0.00
组间·时点间		F=1.968 P=0.121

组别	例数	治疗后1 d				治疗后7 d				治疗后14 d
组别	例数	有效	无效	加重	死亡	有效	无效	加重	死亡	有效	无效	加重	死亡
瑞替普酶组	31	20(64.5)	9(29.0)	2(6.5)	0	24(77.4)	5(16.1)	0	2(6.5)	25(80.6)	4(12.9)	0	2(6.3)
尿激酶组	32	10(31.3)	17(53.1)	5(15.6)	0	15(46.9)	10(31.3)	5(15.6)	2(6.3)	17(53.1)	8(25.0)	5(9.4)	2(6.3)
Z值		2.588				2.447				2.266
P值		0.010				0.014				0.023