| Objective:1.To clarify the effect of early thrombolysis of recombinant tissue plasminogen activator(rt-PA)on the short-term treatment efficiency,long-term efficacy and prognosis of patients with mild stroke;2.To discuss the use of rt-PA in patients with mild stroke Bleeding risk and reliability of thrombolytic therapy;3.To explore the short-term effective rate and long-term prognosis of light stroke patients with different baseline NIHSS scores,different ages and different OTT(onset to treatment time)time after receiving thrombolytic therapy.Methods:A total of 166 patients with mild stroke admitted to the Stroke Center of our hospital from January 2018 to December 2019 were included as the research object,and the research objects were divided into two groups:110 patients in the thrombolysis group received early alteplase Among the patients treated with intravenous thrombolysis,56 patients in the control group were patients receiving traditional medical treatment.The NIHSS score scale was used to evaluate the early neurological deterioration rate and short-term effectiveness of the patients.The modified Rankin score was used to evaluate the long-term prognosis of the two groups of patients.The CT scan of the head clearly identified the occurrence of symptomatic intracranial hemorrhage and intracranial hematoma events Rate;divide the patients receiving thrombolysis into two subgroups of 0-3h and 3-4.5h according to different OTT time points,and divide them into lower age group(<80 years old)and advanced age group(≥80 years old)according to age.3.Analyze and compare the long-term curative effect,and observe whether the probability of intracranial hemorrhage and symptomatic intracranial hematoma has a statistically positive result.Results:1.The NIHSS scores of the patients in the thrombolytic group at 24h and 7d were significantly lower than the initial baseline NIHSS scores at admission,and the NIHSS scores of the control group patients at the critical moment were only 7d at baseline.The effective rate of the thrombolytic group at the critical time point(24h,7d)after treatment was higher than that of the control group.The early neurological deterioration rate in the thrombolytic group was 5.5%,much lower than that in the control group(17.9%).In terms of long-term prognosis,86.4%of patients in the mild stroke thrombolysis group achieved relatively good long-term prognosis(mRS<2 points),compared with 73.2%in the control group.The above differences are statistically significant.The probability of recurrence within 3 months in the thrombolysis group was 8.20%,which was lower than 10.07%in the control group,but there was no significant difference between the two groups(8.20%vs 10.07%,P=0.591).2.The bleeding conversion results of the two groups showed that the probability of bleeding conversion in the thrombolytic group was slightly higher than that of the control group,but the difference was not statistically significant(6.4%vs 1.8%,P=0.193).There were no cases of intracranial hematoma and death causing neurological deficits in all patients.3.The patients in the thrombolysis group were divided into two subgroups according to different OTT times,including 42 patients in the 0-3h subgroup and 68 patients in the 3-4.5h subgroup.The OTT=0-3h subgroup 7d effective rate was slightly higher than the OTT=3-4.5h subgroup,the difference was not statistically significant(85.7%vs 70,6%,P=0.070).On the 90d good prognosis,the 0-3h subgroup had a good prognosis rate of 95.2%,which was higher than the 3-4.5h subgroup(80.9%).The difference was statistically significant(P=0.033).There was no significant difference in the risk of intracranial hematoma between the two groups(4.8%vs 7.4%,P=0.890).4.According to age,patients in the thrombolysis group were divided into subgroups less than 80 years old(85 cases)and subgroups greater than or equal to 80 years old(25 cases).Among them,the short-term effective rate and good long-term prognosis rate of the younger age group are significantly higher than those of the old age group.The above differences were statistically significant(80.3%,91.5%vs 41.7,66.7;P=0.004,0.014).In this study,there was no significant difference in the occurrence of intracranial hemorrhage between the two subgroups(4.7%vs 12.0%,P=0.397).5.The patients in the thrombolysis group were divided into 102 cases in subgroups 0-3 and 18 cases in subgroups 4-5 according to the initial baseline NIHSS score at admission.Analysis of the 0-3 subgroup’s recent treatment effective rate was 84.7%and the 4-5 subgroup(48.0%)was not statistically different.In terms of long-term prognosis and incidence of intracranial hematoma,there was no significant difference between the two groups(92.9%vs 64.0%P<0.001;6.9%vs 0%P=1.000).Conclusion:1.Early intravenous thrombolysis of rt-PA did not increase the occurrence of intracerebral hematoma and hemorrhagic transformation events that cause neurological deficits in patients,and it is relatively safe and reliable.It can also improve the effectiveness of short-term treatment of patients with mild stroke and prevent the occurrence of early neurological deterioration.Although thrombolysis can improve the long-term prognosis,it is ineffective in preventing the recurrence of stroke within 3 months,2.Patients with mild stroke can benefit from receiving rt-PA intravenous thrombolysis within the time window;but they should receive thrombolysis as soon as possible.From the study results,the 3-4.5 hour subgroup is within the 0-3 hour subgroup When comparing,it was found that the OTT time was inversely proportional to the patient’s prognosis.3.Patients with mild stroke under 80 years of age should more actively recommend intravenous thrombolytic therapy.After receiving thrombolytic therapy in patients over 80 years of age,the prognosis has not been significantly improved in the short and long term,and the risk-benefit ratio of thrombolytic therapy should be fully considered.4.Light stroke patients with baseline NIHSS scores at different admissions have no significant difference in short-term treatment efficiency and long-term prognosis after receiving rt-PA early intravenous thrombolysis. |
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