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目的::静脉溶栓治疗是急性缺血性卒中最有效的治疗方法。本研究旨在探讨在现行卒中指南的指导下,静脉溶栓治疗的早期疗效和远期预后,以期为提高静脉溶栓治疗的获益提供临床证据。方法::记录136例接受重组组织型纤溶酶原澈活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗的急性缺血性卒中患者的人口统计学特征、血管危险因素和本次卒中发生的情况。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)对静脉溶栓治疗的早期疗效进行评价,改良Rankin量表(modified Rankin scale,mRS)对卒中发生后3个月时的功能独立情况进行评价。采用单因素和多因素分析对静脉溶栓治疗的早期疗效和卒中发生后3个月时功能独立的相关影响因素进行分析。结果::静脉溶栓治疗后24 h时,早期有效66例(48.5%);卒中发生后3个月时,64例(47.1%)达功能独立。静脉溶栓治疗后2 h、24 h和7 d的早期疗效与卒中发生后3个月时的功能独立显著相关(P值均<0.05)。静脉溶栓治疗前收缩压是静脉溶栓治疗早期疗效的独立影响因素(P<0.05)。结论::降低静脉溶栓治疗前收缩压可能改善溶栓治疗的早期疗效。依据溶栓治疗的早期疗效,可能判断溶栓治疗的远期预后。
Purpose :: Intravenous thrombolysis is the most effective treatment for acute ischemic stroke. This study aimed to investigate the early and long-term prognosis of intravenous thrombolysis under the guidance of the current stroke guidelines in order to provide clinical evidence for the benefit of intravenous thrombolysis. METHODS :: The demographics, vascular risk factors, and current risk factors for 136 acute ischemic stroke patients treated with intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) were recorded Stroke happened. The early efficacy of intravenous thrombolysis was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) was evaluated at 3 months after stroke Functional independent evaluation. Univariate and multivariate analyzes were used to analyze the early efficacy of intravenous thrombolysis and the associated functional independence at 3 months after stroke. Results: Sixty-six patients (48.5%) were effective early after intravenous thrombolysis and 64 patients (47.1%) achieved independence three months after stroke. Early effects at 2, 24, and 7 days after intravenous thrombolysis were significantly associated with functional independence at 3 months after stroke (P <0.05). The systolic blood pressure before intravenous thrombolysis was an independent factor influencing the early curative effect of intravenous thrombolysis (P <0.05). Conclusions: Reducing the systolic blood pressure before thrombolysis may improve the early curative effect of thrombolytic therapy. According to the early curative effect of thrombolytic therapy, the long-term prognosis of thrombolytic therapy may be judged.