Clinical Efficacy And Safety Analysis:rt-PA Intravenous Thrombolytic Therapy For Acute Ischemic Stroke

Background:Stroke is the fourth leading cause of death next only to heart disease,cancer and respiratory diseaseThe third cause of death of the2004-2005national retrospective sampling survey report shows, cerebrovascular disease has jumped to the top of the national cause of death.Currently lack the ideal method of treatment, and intravenous thrombolytic therapy may be more significant to improve the prognosis of patients with cerebral infarction, especially for thrombolytic international study of intravenous thrombolysis, but the impact of the efficacy and safety of intravenous thrombolysisthe factors remains controversial.Part Ⅰ Clinical efficacy of rt-PA intravenous thrombolytic therapy for acute ischemic strokeObjection:Explore the validity of China, especially Shanghai population intravenous thrombolytic therapy in the thrombolysis time window within nine hours.Method:Patients admitted to our hospital from June2008to December2012, whose cases met the the intravenous thrombolysis standards and received altepase treatment were retrospectively studied.Collected the date of the patient’s age, sex, weight, risk factors, and thrombolytic time window, blood pressure, Blood glucose levels, rt-PA dose cranial CT data before thrombolysis, thrombolysis after2hours and24-hour cranial CT results, TOAST stroke subtype classification.If any change occured in the patient’s condition, brain CT would be rechecked at any time.Recorded the use of antiplatelet agents and anticoagulants and NIHSS scores before and after intravenous thrombolysis, and24th hours,at7days,14days,30days,90days, six months of continuous NIHSS mRS and Bland other assessment data.Taking the NINDS study placebo control group as the control group in this study.Recent effective indicators include NIHSS minus4points or more NIHSS reduced to0; Long-term prognosis indicators include BI3months follow-up for95points or100points, NIHSS and mRS In the1minute and less.Using the two classification logistics multivariate analysis method to analyze the impact of thrombolytic therapy efficacy, safety factors and intracranial hemorrhage.Results:1.72cases of acute cerebral infarction in patients with average age of62.05±13.53years old, female and28(38.36%), the average time of onset to treatment was229.97±81.48min.2. The median before thrombolysis NIHSS score is13(4-23),24hours after thrombolysis NIHSS score that improved in43cases (59.7%),39.1%higher than that of the control (p=0.001)3. Of thrombolytic treatment group and the control group compared to visible,90days improved prognosis NIHSS, mRS and BI values were statistically significant (p <0.05).Conclusion:Cerebral infarction intravenous thrombolytic therapy within the time window is relatively safe and effective immediately after thrombolysis, improvement and improvement of24hours for90days can predict prognosis to improve the situation. Part Ⅱ The safety of rt-PA intravenous thrombolytic therapy for acute ischemic strokeObjection:Explore the security of intravenous thrombolytic therapy in the thrombolysis time window within nine hours in China, especially Shanghai population and analyze the relevant factors affecting the intravenous thrombolysis prognosis and intracranial hemorrhage incidence.Method:Baseline method is the same. According to the ECCAS Ⅱ, ICH is divided into two categories and4types:HI-1and HI-2, PH-1, PH-2type.Statistical methods adopting the chi-square test analysis of the treatment group and the control group, the difference in the safety and efficacy of the long-term prognosis indicators with the former.Statistical methods adopting the chi-square test analysis of the difference between the treatment group and the control group in the aspects of safety and efficacy. The long-term prognosis of criterion-referenced previously.Using the two classification logistics multivariate analysis method to analyze the impact of thrombolytic therapy efficacy, safety factors and intracranial hemorrhage.Results:1. Occurred in72cases, ICH13(17.8%), sICH7cases (9.72%) and fatal bleeding in one case (1.39%);Two cases based on CT images parting HI-3, HI-2, PH-1type6cases, PH-2type1cases.2. ICH incidence in different time windows within:0-3hour time window for the three cases, SiCH1;3-4.5h inside,6cases;sICH4cases;4.5-6h ICH2cases;6-9hICH1.3. The time distribution of ICH occurred:0-6h after thrombolysis ICH3cases;0case within6-12h and12-24h;4cases of24-36h;36h-3d in three cases;3d-7d three cases. Meanwhile sICH0-6h after thrombolysis1cases;2cases of24-36h;36h-3d two cases;3d-7d two cases.4. CT imaging findings:lobar hemorrhage, basal ganglia hemorrhage four cases, the edges of the lobes of the brain; cerebellar hemorrhage in two cases.5. ICH clinical outcome:the ICH group early neurological deterioration was15.4%; ICH group was significantly higher than5.1%.6. ICH the different images subtypes clinical outcomes:comparison with non-ICH group, HI1, HI2, as well as the PHI long-term prognosis is good. High PH2death.7. PH-2type ICH risk factors analysis:the Multivariate Logistic analysis showed that blood glucose≥11.1mmol/L, and age>80years for hemorrhagic transformation after90days of the important poor prognosis factors.Conclusion:rt-PA intravenous thrombolysis of acute stroke patients line, PH2-type hemorrhagic transformation poor long-term prognosis; Only a minority, the intravenous thrombolysis relatively safe and reliable. Caused hemorrhagic transformation of the PH-2risk factors for blood glucose≥11.1mmol/L, and senior citizens.