心房颤动对不同时间窗内急性缺血性脑卒中患者静脉溶栓疗效的对比研究

目的:探讨与对比心房颤动对不同时间窗内急性缺血性脑卒中患者静脉溶栓疗效的影响。方法:选择2014年8月到2016年5月在我院进行诊治的急性缺血性脑卒中患者98例,其中卒中前已诊断心房颤动定义为慢性心房颤动组(n=50),入院后诊断心房颤动者为新发心房颤动组(n=48);两组都给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,记录两组预后情况。结果:两组患者的性别、年龄、时间窗、合并疾病、血糖与甘油三酯含量对比无明显差异(P0.05)。慢性心房颤动组与新发心房颤动组的有效率分别为94.0%和95.8%,组间比较差异无统计学意义(P0.05)。慢性心房颤动组与新发心房颤动组治疗后的m RS评分分别为6.22±1.83分和6.29±1.45分,都明显低于治疗前的9.24±1.31分和9.19±1.52分(P0.05),组间对比无明显差异(P0.05)。慢性心房颤动组的症状性脑出血与非症状性脑出血发生率分别为4.0%和2.0%,都明显低于新发心房颤动组的14.6%和12.5%(P0.05)。结论:发病4.5h之内静脉溶栓急性缺血性脑卒中是安全有效的,新发心房颤动不影响患者静脉溶栓后的神经功能结局,但是会增加症状性脑出血与非症状性脑出血,需要加强预防性管理。

A Comparative Study on the Efficacy of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Atrial Fibrillation in Different Time Windows

ABSTRACT Objective: To investigate the effects of intravenous thrombolysis in patients with acute ischemic stroke in different time windows. Methods: Used the prospective method, 98 acute ischemic stroke patients with atrial fibrillation were treated from 2014 August to May 2016 in our hospital for diagnosis and treatment were selected that included before stroke diagnosed atrial dithering were the chronic atrial fibrillation group (n=50), and after admission diagnosis of atrial fibrillation were the new atrial fibrillation group (n=48); Two groups were given recombinant tissue type plasminogen activator (rt-PA)thrombolytic therapy, recorded the outcome in the two groups. Results: There were no significant differences in gender, age, time window, disease, blood glucose and triglyceride levels com- pared between the two groups (P>0.05). The efficiency in the chronic atrial fibrillation group and the new atrial fibrillation groupwere 94.0% and 95.8% that compared between the two groups were not significant difference (P>0.05). The mRS scores in the chronic atrial fibrillation group and new atrial fibrillation group after treatment were 6.22±1.83 points and 6.29±1.45 points, were significantly lower than the treatment of 924±1.31 points and 9.19±1.52 points (P<0.05) that compared between the groups were not significant difference (P>0.05). The symptomatic intracerebral hemorrhage and non symptomatic cerebral hemorrhage rates in the chronic atrial fibrillation group were 4.0% and 2.0% respectively that were significantly lower than 14.6% and 12.5% in the new atrial fibrillation group(P<0.05). Conclusion: Within 4.5 hours of onset intravenous thrombolysis for acute ischemic stroke is safe and effective, and the new atrial fibrilla- tion does not affect neurologic outcome after intravenous thrombolysis, but will increase the rates of symptomatic cerebral hemorrhage and non symptomatic cerebral hemorrhage that need strengthen the prevention and management.