阿替普酶静脉溶栓前应用依达拉奉对老年急性脑梗死预后的影响

doi:10.3969/j.issn.1003-9198.2021.03.023

摘要/Abstract

摘要： 目的探讨老年急性脑梗死病人在应用阿替普酶(recombinant tissue plasminogen activator,rt-PA)静脉溶栓前预先使用依达拉奉的有效性和安全性。方法采用回顾性分析的方法,纳入2014～2018年南京医科大学第二附属医院脑卒中登记系统中接受rt-PA静脉溶栓及依达拉奉联合治疗的老年急性脑梗死病人,共135例。依据应用rt-PA静脉溶栓和依达拉奉的前后顺序,将病人分为依达拉奉前治疗组(67例)和依达拉奉后治疗组(对照组,68例)。分析2组病人在rt-PA静脉溶栓24 h、7 d后NIHSS评分,90 d改良Rankin量表(modified Rankin Scale,mRS)评分,溶栓后颅内出血和症状性颅内出血的发生率以及7 d、90 d死亡率等。应用Logistic回归分析方法探讨治疗后90 d预后的影响因素。结果 2组24 h及7 d NIHSS评分差异有统计学意义[(8.67±8.55)分比(11.88±8.30)分;(5.08±5.35)分比(8.60±7.91)分]。2组90 d良好预后率差异有统计学意义(53.73% 比27.94%) 。溶栓后,依达拉奉前治疗组脑出血发生率(9.1% 比18.3%,P＜0.01)、症状性脑出血发生率(2.0%比8.7%,P＜0.01)明显低于依达拉奉后治疗组,差异有统计学意义。2组7 d死亡率差异无统计学意义(4.0%比4.9%),依达拉奉前治疗组90 d死亡率明显低于依达拉奉后治疗组,差异有统计学意义(4.0%比12.5%,P=0.04) 。Logistic回归分析显示,依达拉奉前治疗为预后良好的独立影响因素(OR=0.28,95%CI:0.14~0.58)。结论在老年急性脑梗死病人中,rt-PA静脉溶栓前使用依达拉奉对90 d后神经功能改善效果优于溶栓后使用,同时可明显降低症状性脑出血发生率。

关键词: 急性脑梗死, 老年人, 依达拉奉, 阿替普酶, 预后

Abstract: Objective To investigate the effect edaravone before or after recombinant tissue plasminogen activator (rt-PA) on the outcome of acute ischemic stroke in the elderly patients. Methods A retrospective cohort study was conducted using the stroke register database in the Second Affiliated Hospital of Nanjing Medical University. A total of 135 elderly patients with ischemic stroke from 2014 to 2018 were selected. The patients received edaravone before rt-PA administration were enrolled as study group (n=67), and those who received edaravone after rt-PA were enrolled as control group (n=68). The scores of modified Rankin Scale (mRS) 90 d after treatment, National Institutes of Health Stroke Scale (NIHSS) scores 24 h and 7 days after intravenous thrombolysis, the incidence rate of acute cerebral infarction hemorrhagic transformation, 7-day and 90-day mortality were compared between the two groups. Results The NIHSS scores 24 h and 7 days after intravenous thrombolysis were lower in study group than those in control group (8. 67±8. 55 vs 11. 88±8. 30; 5. 08±5. 35 vs 8. 60±7. 91), 90 d recanalization rate was higher in study group than that in the control group (53. 73% vs. 27. 94%). The rates of intracranial hemorrhage (ICH) (9. 1% vs. 18. 3%) and the rate of symptomatic intracranial hemorrhage (sICH) (2. 0% vs. 8. 7%) in study group were lower than those in control group. Logistic regression analysis showed that the administration of edaravone before rt-PA was significantly associated with lower mRS scores of the patients (OR=0. 28, 95%CI: 0. 14-0. 58). Conclusions The administration of edaravone before rt-PA may improve the outcome in the elderly patients with acute ischemic stroke treated with rt-PA.

Key words: acute ischemic stroke, aged, edaravone, recombinant tissue plasminogen activator, outcome

中图分类号:

R 743.33

丁桂兵, 吴岩峰, 陈亮, 吴晋, 张鹏. 阿替普酶静脉溶栓前应用依达拉奉对老年急性脑梗死预后的影响[J]. 实用老年医学, 2021, 35(3): 301-305.

DING Gui-bing, WU Yan-feng, CHEN Liang, WU Jin, ZHANG Peng. Effects of edaravone on outcomes in the elderly patients with acute ischemic stroke treated with recombinant tissue plasminogen activator[J]. Practical Geriatrics, 2021, 35(3): 301-305.

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