中国全科医学2017，Vol.20Issue(1)：56-61,6.DOI:10.3969/j.issn.1007-9572.2017.01.012
伴未破裂颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性评价研究
Safety of Intravenous Thrombolysis in Treating Acute Cerebral Infarction Patients Combined with Unruptured Intracranial Aneurysms
摘要
Abstract
Objective To evaluate the safety of intravenous thrombolytic therapy in patients with acute cerebral infarction(ACI)combined with unruptured intracranial aneurysms(UIAs)in the thrombolysis time window. Methods A total of 245 patients with ACI who received intravenous thrombolysis therapy in the Stroke Unit of Department of Neurology of the First Affiliated Hospital of the Medical College,Shihezi University from January 2010 to December 2015 were enrolled. All subjects received intravenous thrombolytic therapy of recombinant tissue - type plasminogen activator alteplase ( rt - PA ) . After thrombolysis,patients were reexamined with brain CT scan within 36 hours,and intracranial vascular assessment was completed between 36 hours and 7 days. All patients were divided into group without UIAs( n = 224)and group with UIAs( n = 21) according to their vascular assessment results. The National Institute of Health Stroke Scale( NIHSS)score of patients in two groups before thrombolysis and seven - day after thrombolysis,their modified Rankin Scale( mRS)grading after 90 - day thrombolysis and bleeding condition after thrombolysis were recorded and compared. Results A total of 21 patients combined with UIAs(8. 6% )were detected,and 25 UIAs,a diameter between 2. 0 to 8. 0 mm and an average diameter of(4. 1 ± 1. 7) mm. There was no significant difference in gender,average age,smoking proportion,drinking proportion,and proportion of combining with diabetes,hypertension,hyperlipemia and atrial fibrillation,time from onset to thrombolysis,and BMI,systolic blood pressure and diastolic blood pressure before intravenous thrombolysis,the fasting blood glucose( FPG),glycosylated hemoglobin(HbA1c ),total cholesterol( TC),triglyceride ( TG),platelet count and serum uric acid in the day after thrombolysis of patients between two groups(P ﹥ 0. 05);the levels of low density lipoprotein(LDL)and homocysteine in the day after thrombolysis in group with UIAs were significantly lower than those in group without UIAs( P ﹤ 0. 05). Before and seven - day after thrombolysis,the NIHSS scores of the two groups were not significantly different(P ﹥ 0. 05);seven - day after thrombolysis,the NIHSS score of patients in the two groups was significantly lower than that before thrombolysis(P ﹤ 0. 05). After 90 - day thrombolytic therapy,the proportion of patients with the mRS from 0 to 2 grade in the two groups was not significantly different( P ﹥ 0. 05) . There was no significant difference in the incidence of non - symptomatic intracranial hemorrhage(N-sICH),symptomatic intracranial hemorrhage(sICH)and subarachnoid hemorrhage(SHA)of patients in the two groups after thrombolysis(P ﹥ 0. 05). Conclusion For ACI patients combined with UIAs that not larger than 8. 0 mm,the intravenous thrombolysis therapy might not increase the rupture hemorrhage risk of aneurysms. This provides basis for the selection and judgment of patients with intravenous thrombolysis,but the results still need to be confirmed with studies on large samples.关键词
脑梗死/颅内动脉瘤/血栓溶解疗法/安全性Key words
Brain infarction/Intracranial aneurysm/Thrombolytic therapy/Security分类
医药卫生引用本文复制引用
耿玉荣,柳英杰,张云霞,刘春红,王宏,张惠丽..伴未破裂颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性评价研究[J].中国全科医学,2017,20(1):56-61,6.基金项目
国家自然科学基金资助项目 （）
