| 【Objective】To investigate the clinical efficacy and safety of rt-PA intravenous thrombolysis in patients with acute ischemic stroke in 3-4.5 hours,and analyze the changes and influencing factors of thrombolysis rate from <3h to 3-4.5h.【Method】Retrospective analysis of 296 patients with acute ischemic stroke and onset time<4.5h in Department of Emergency and Neurology,the First Affiliated Hospit-al of Quanzhou,Fujian Medical University,from 2015.1 to 2016.12.According to whether the patients receiving rt-PA thrombolysis and their onset time(<3h or 3-4.5h),patients were divided into four groups:<3h thrombolysis group,3-4.5h thrombolysis group,<3h non-thrombolytic group,3-4.5h non-thrombolytic group.Compar-ed the efficacy(NIHSS score,cerebral blood flow changes,90 d mRS score)and s-afety(cerebral hemorrhage and other complications,90 d total mortality)in 3-4.5h non-thrombolysis group,<3h thrombolysis group,and 3-4.5h thrombolysis group.And analyze the influencing factors of thrombolysis rate in 3-4.5 hours.【Result】(1)Comparison of efficacy:(1)NIHSS scores:in 3-4.5h thrombolysis group,the median NIHSS scores of 24 h,7 d after thrombolysis were 8.00(5.00-12.00),7.00(3.00-10.00).There was no significant difference between 3-4.5h thrombolysis group and,<3h thrombolysis group(P>0.05).The score was significantly decreased compared with 3-4.5h non-thrombolytic group(P<0.05).(2)Cerebral blood flow:in 3-4.5h thrombolysis group,the middle cerebral artery Vm of 1h,7d after thrombolysis were(61.26±15.02)cm/s,(75.31±9.85)cm/s,and PI were(0.86±0.16),(0.75±0.04).Compared with 3-4.5h non-thrombolysis group,Vm significantly increased(P<0.05)and PI significantly decreased(P<0.05).Compared with the 3h thrombolysis group there was no significant difference(P>0.05).(3)The rate of good prognosis(mRS0-2)at 90d:3-4.5h thrombolysis group,3-4.5h non-thrombolytic group,<3h thrombolysis group were 43.75%,25.61%,46.43%.The mRS0-2 of 3-4.5h th-rombolysis group was higher than that of 3-4.5h non-thrombolysis group(P<0.0125).There was no significant difference between the 3-4.5h thrombolysis group and the <3h thrombolysis group(P> 0.0125).(2)Comparison of safety:(1)cerebral hemorrhage rate:The total cerebral hemorrhage rate of 3-4.5h thrombolysis group,3-4.5h non-thrombolytic group,<3h thrombolysis group were15.62%,12.80%and 10.71%,(P>0.05).The symptomatic cerebral hemorrhage rates were 7.81%,7.14% and 6.71%,respectively(P>0.05).(2)There was no significant difference in complication of gastrointestinal bleeding,oral gingival bleeding,pulmonary infection and secondary epilepsy among the three groups(P>0.05).(3)The total mortality rate of 90d:3-4.5h thrombolysis group,3-4.5h non-thrombolytic group,<3h thrombolysis group were 7.81%,11.60% and 7.14%.There was no significant difference among three groups(P>0.05).(3)The thrombolysis rate was 28.07%(64/228)in 3-4.5 h,which was lower than that(41.18%,28/68)in <3h.The influencing factors:(1)Patients/families rejection accounted for 67.68%,including 40.54% for fearing of bleeding/death risk of 3-4.5h higher than <3h,and27.92% for mild symptoms/rapid recovery.(2)The onset to admission time in 4-4.5h,the relevant thrombolytic examination which could not be completed,and no thrombolysis accounted for12.20%.(3)Too long time for informed consent accounted for10.98%.(4)Negative thrombosis where doctors worried about bleeding / death and other complications accounted for 7.32%.(5)The hospital equipment for failure of head CT and other tests accounted for 1.83%.【Conclusion】(1)In the time window of 3-4.5h,the rt-PA thrombolysis can still obtain remarkable clinical effects and prognosis.(2)The rt-PA thrombolysis in the 3-4.5h time window does not increase the risk of symptomatic cerebral hemorrhage and death.(3)The total number of thrombolytic patients was increased after prolonged time window,The time window of 3-4.5h was significantly higher than that of<3h,but the thrombolysis rate was lower than that of latter.The main reason might be that most patients were worried about prolonged risk of bleeding and death due to prolonged thrombolysis. |
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