李婧,
吕晓培,
梁晓雪,
习玉芳,
卢海丽,
李虹,
张斌,
康梅,
杨爱丛,
王聪杰^,
石家庄市人民医院 神经内科三病区, 河北 石家庄 050011

基金项目: 河北省医学科学研究重点课题计划（20181012）


详细信息 作者简介: 李婧(1982-), 女, 主治医师。E-mail:ourhome_2008@163.com










通讯作者: 王聪杰, 主治医师。E-mail:506218939@qq.com 中图分类号: R743.32


摘要:目的探讨载体动脉堵塞穿支型小卒中脑梗死超早期静脉溶栓联合双重抗血小板聚集的临床疗效，并评价其安全性。方法收集2014年1月至2019年9月NIHSS评分≤4分的急性脑梗死患者200例，分为观察组118例和对照组82例。观察组给予重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓后给予双重抗血小板药物治疗3周，之后长期阿司匹林维持；对照组给予静脉溶栓后阿司匹林长期治疗。比较两组患者美国国立卫生研究院卒中量表（the national institutes of health stroke scale，NIHSS）评分、显效率、总有效率、Barthel指数（Barthel index，BI）评分、改良Rankin量表（modified Rankin scale，mRS）评分、不良反应、并发症及卒中复发率等。结果两组在治疗后24 h NIHSS评分差异不明显（P>0.05）；但两组在治疗后72 h和1周，NIHSS评分均逐渐降低，且观察组均低于对照组，差异有统计学意义（P < 0.05）；治疗后1周观察组和对照组临床总有效率分别为81.4%和61.0%，差异有统计学意义（P < 0.05）；两组经过治疗后1周、2周，其BI评分均逐渐升高，观察组BI评分高于对照组，差异均有统计学意义（P < 0.05）；治疗2周及3个月，观察组mRS评分明显低于对照组（P < 0.05）；观察组患者发病3月内复发率低于对照组，分别为1.7%及6.1%（P < 0.05）。结论rt-PA静脉溶栓联合双重抗血小板聚集治疗可有效减轻载体动脉阻塞穿支型小卒中脑梗死患者的残疾程度及预后，无严重不良反应，安全性高，且二级预防效果更好，值得临床推广。
关键词: 小卒中/
静脉溶栓/
穿支动脉堵塞穿支/
抗血小板/
安全性


Abstract:ObjectiveTo explore the clinical effect of super-early venous thrombolysis combined with dual antiplatelet aggregation in patients with middle cerebral infarction with carrier artery occlusion and perforation, and to evaluate its safety.MethodsFrom January 2014 to September 2019, 200 patients with acute cerebral infarction with NIHSS score≤4 were retrospectively collected and divided into observation group (118 cases) and control group (82 cases). The observation group was given recombinant tissue-plasminogen activator (rt-PA) intravenous thrombolysis followed by dual antiplatelet drug therapy for 3 weeks, followed by long-term maintenance of aspirin. The national institutes of health stroke scale (NIHSS) score, significant efficiency, total effective rate, Barthel index (BI) score, modified Rankin scale (mRS) score, adverse reactions, complications and stroke recurrence rate were compared between the two groups. The control group was given long-term aspirin treatment after intravenous thrombolysis. The effective rate, adverse reactions and recurrence rate of the two groups were compared.ResultsThere was no significant difference in NIHSS scores between the two groups at 24 hours after treatment (P>0.05), but the NIHSS scores of the two groups decreased gradually at 72 hours and 1 week after treatment, and the NIHSS scores of the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). One week after treatment, the clinical total effective rates of the observation group and the control group were 81.4% and 61.0%, respectively, and the difference was statistically significant (P < 0.05). After 1 week and 2 weeks of treatment, the BI scores of the two groups were gradually increased, and the BI score of the observation group was higher than that of the control group, and the differences were statistically significant (P < 0.05). After 2 weeks and 3 months, the mRNA score of observation group was significantly lower than that of the control group (P < 0.05). The recurrence rate of the observation group was lower than that of the control group after 3 months, which were 1.7% and 6.1% respectively(P < 0.05).Conclusionrt-PA intravenous thrombolysis combined with dual antiplatelet aggregation therapy can effectively reduce the disability degree and improve prognosis of patients with carrier artery occlusion and perforation type pawn middle cerebral infarction. It is safe with no serious adverse reactions, has better secondary prevention effect, and is worthy of clinical promotion.
Keywords:minor stroke/
intravenous thrombolysis/
perforating artery blocked perforator/
antiplatelet/
safety

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