目的 探讨不同剂量阿替普酶对70岁以下急性缺血性脑卒中(AIS)患者的治疗效果和安全性.方法 选择2012年10月~2016年6月在聊城市中医医院就诊,年龄<70岁的AIS患者184例,随机分为标准剂量组(93例)和低剂量组(91例),分别给予0.9 mg/kg和0.6 mg/kg阿替普酶进行静脉溶栓治疗,比较两组的死亡率和治疗后90 d改良Rankin评分量表(mRS)评分的差异,同时评价症状性颅内出血(SICH)和其他不良事件的发生率.结果 两组分别有92例和91例患者完成研究.两组患者发病后90 d内死亡率分别为10.87%和8.79%,治疗后72 h内死亡或神经功能恶化率分别为14.13%和12.09%,组间比较差异均无统计学意义(P>0.05).两组患者的mRS分布组间比较差异无统计学意义(P>0.05).两组随访期间SICH发生率分别为7.61%和5.49%,治疗及随访期间不良事件总体发生率分别为19.56%和18.68%,组间比较差异均无统计学意义(P>0.05).结论 低剂量阿替普酶对非高龄急性缺血性脑卒中有较好的溶栓效果,预后和出血转化风险与标准剂量相当.%Objective To evaluate the effect and safety of different doses of alteplase on acute ischemic stroke (AIS) patients less than 70 years old. Methods From October 2012 to June 2016,184 AIS patients less than 70 years were randomly divided into standard dose group (n=93) and low dose group (n=91). 0.9 mg/kg and 0.6 mg/kg alteplase were given for intravenous thrombolysis respectively. The differences in the mortality rate and modified Rankin Scale (mRS) were compared between two groups at 90 days after treatment. The incidence of symptomatic intracranial hemorrhage (SICH) and other adverse events were evaluated meantime. Results Totals of 92 cases and 91 cases in two groups completed the study respectively. The mortality rates of patients in two groups were 10.87% and 8.79% within 90 days after onset of the disease respectively. There was no significant difference between two groups (P>0.05). The death or neurological deterioration rate in 72 h after onset of the disease in two groups was 14.13% and 12.09% (P>0.05). There was no significant difference in mRS distribution between two groups (P>0.05). The incidence of SICH in two groups was 7.53% and 5.49%respectively (P> 0.05). The overall incidence of adverse events in two groups was 19.35% and 18.68% (P> 0.05). Conclusions The thrombolytic effect of low-dose alteplase on non-elderly acute ischemic stroke patients is well. The prognosis and risk of hemorrhagic transformation are comparable to the standard dose.
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