尿激酶静脉溶栓治疗高龄急性缺血性脑卒中患者疗效观察

摘要

目的 探讨尿激酶静脉溶栓治疗高龄急性缺血性脑卒中患者的临床疗效及安全性.方法 选取2013年3月至2017年6月重钢总医院收治的高龄 (80～90岁) 急性缺血性脑卒中患者102例, 其中51例接受尿激酶溶栓及常规治疗 (溶栓组) , 另51例接受常规治疗 (对照组) .分析2组患者治疗前, 治疗后24h、14d及90d的日常生活能力 (ADL) , 以及2组患者24h、14d美国国立卫生研究院卒中量表 (NIHSS) 评分, 观察2组患者不良反应发生情况.结果 溶栓组治疗后24h, 14、90d的ADL评分均明显低于治疗前, 且治疗后14、90d的ADL评分明显低于对照组, 差异均有统计学意义 (P<0.05) .溶栓组治疗后24h、14d的NIHSS评分均明显低于治疗前及对照组治疗后, 差异均有统计学意义 (P<0.05) .溶栓组发生牙龈出血4例 (7.8％) , 穿刺点周围瘀斑3例 (5.9％) , 消化道出血1例 (2.0％) , 缺血性脑卒中出血转化4例 (7.8％) ;对照组发生消化道出血2例 (3.9％) , 缺血性脑卒中出血转化3例 (5.9％) .对症处理后上述症状均消失或改善, 均无死亡病例.结论 尿激酶静脉溶栓治疗高龄急性缺血性脑卒中患者疗效优于常规治疗, 能显著改善日常生活能力、神经功能缺损及预后, 提高患者生活质量.%Objective To investigate the clinical efficacy and safety of intravenous thrombolytic therapy with urokinase in elderly patients with acute ischemic stroke.Methods 102 cases elderly patients (80-90 years old) with acute ischemic stroke in the General Hospital of Chongqing Steel Companyfrom March 2013 to June 2017 were enrolled in the study.Fifty-one cases patients underwent urokinase thrombolysis and conventional therapy (thrombolysis group) , and 51 cases patients received conventional therapy (control group).The ADL before and after treatment at 24 h, 14 dand 90 d, NIHSS scores after treatment at 24 h, 14 d of both groups were analyzed.Complications were observed in 2 groups, and ADL scores were analyzed after 90 days of follow-up.Results Compared with before treatment, the ADL scores of thrombolysis group were significantly decreased at 24 h, 14 dand 90 d after treatment, the differences were statistically significant (P<0.05).Compared with before treatment and control group after treatment, the NIHSS scores of thrombolysis group were significantly decreased at 24 hand 14 dafter treatment, the differences were statistically significant (P<0.05).In the thrombolysis group, there were 4 cases of gingival hemorrhage (7.8％) , 3 cases of puncture site stasis (5.9％) , 1 case of gastrointestinal hemorrhage (2.0％) , and 4 cases of ischemic stroke hemorrhage trasformation (7.8％).In the control group, there were 2 cases of gastrointestinal hemorrhage (3.9％) and 3 cases of ischemic stroke hemorrhage transformation (5.9％).After symptomatic treatment, the above symptoms disappeared or improved, no deaths.ConclusionThe efficacy of intravenous thrombolysis with urokinase in elderly patients with acute ischemic stroke is superior to the conventional therapy, which can significantly improve the daily living ability and neurological function defects, prognosis and quality of life of patients.