| Objective: Acute cerebral infarction is one of the disease which harm to human life and health seriously, and including cardiac infarction accounts for about 12%-15%. Cardiac infarction caused the attention of clinicians by the feature of rapid onset, large infarct size, neurological damage seriously, treatment difficulty, poorly prognosis and relapse easily. Rt-PA is the most effective drug for the treatment of acute ischemic stroke. Currently, cardiac infarction which accept rt-PA intravenous thrombolysis within three hours time window onset has been proven safe and effective all around the world, but it has few studies in 3-4.5 hours time window onset. Cardiac infarction has severe neurological impairment and conversion rate of intracranial hemorrhage that casued by atrial fibrillation, it makes many doctors have doubt about the effectiveness of thrombolytic. This paper aims to study the effect of thrombolysis in cerebral infarction with atrial fibrillation, whether there are differences in efficacy and safety of intravenous thrombolysis with different time windows, thus providing reference for thrombolytic therapy of cerebral infarction with atrial fibrillation in clinical.Methods:We collect the patients with acute cerebral infarction who visited to the First Affiliated Hospital of Dalian Medical University, neurological of the intensive care unit since January 2012 to December 2014. All patients were given intravenous thrombolysis, The selected patients were divided into the group with atrial fibrillation and the other group without that according to the presence or absence of atrial fibrillation, At the same time, the atrial fibrillation group was divided into within 0-3h thrombolysis group and 3-4.5h thrombolysis group that based on the time from onset to thrombolysis. Recorded the general information,the NIHSS score before thrombolysis and after thrombolysis in 1h, 24 h, 7d, the m RS score after thrombolysis in 90 d, intracranial hemorrhage transformation, symptomatic intracerebral hemorrhage, and death. Using SPSS17.0 software to processing and analysis the data. Analysis the rt-PA thrombolytic efficacy and safety in patients who have cerebral infarction with atrial fibrillation,and whether there are differences in efficacy and safety of rt-PA thrombolytic with different time windows in patients who have cerebral infarction with atrial fibrillation.Result: Collected 131 cases of acute cerebral infarction, included 90 male patients, 41 female patients, 57 cases of patients with atrial fibrillation, 74 cases of patients without atrial fibrillation.1.The efficacy and safety of rt-PA thrombolytic in cerebral infarction with atrial fibrillation: There was no significant difference in the reduction degree of NIHSS score in 1h, 24 h,7d period nither the group with atrial fibrillation nor the group without atrial fibrillation(P>0.05).But the group of atrial fibrillation(38.5%) was worse than the group without atrial fibrillation(70.4%) in 90 d of m RS(0-1) after intravenous thrombolysis, the difference was statistically significant(P <0.01).And the risk of intracranial hemorrhage transformation after intravenous thrombolysis in the group of atrial fibrillation(29.8%) was significantly higher than those without atrial fibrillation(16.3%), the difference was statistically significant(P <0.05). The symptomatic intracerebral hemorrhage and death of two group had no statistically significant difference(P> 0.05). Logistic regression analysis, the results showed that 90 d good prognosis after intravenous thrombolysis was related to Atrial fibrillation on admission(OR=0.743,95%CI 0.654~0.845,P=0.000). Atrial fibrillation is a risk factor of intracranial hemorrhage transformation after intravenous thrombolysis(OR=3.403,95%CI 1.003~11.542,P=0.049).2. The comparison in efficacy and safety of rt-PA thrombolytic with different time windows in patients who have cerebral infarction with atrial fibrillation: The NIHSS scores after thrombolytic therapy in 1 h, 24 h, 7 d of 0-3h group was 13.46±5.15、12.15±5.03、10.20±7.33,The NIHSS scores after thrombolytic therapy in 1 h, 24 h, 7 d of 3-4.5h group was14.31±4.35、13.04±5.67、8.96±5.17,0-3h group thrombolysis group NIHSS score improvement is more obvious than before thrombolysis(P<0.01). However, 0-3h group intravenous thrombolysis 1h, 24 h, 7d various time periods compared with NIHSS score 3-4.5h group intravenous thrombolysis, no statistically significant difference(P> 0.05). 0-3h after intravenous thrombolysis in patients with good prognosis 90 d m RS(0-1) 3-4.5h higher ratio than intravenous thrombolysis(57.1% vs 27.6%,χ2=5.105,P=0.024).two groups after thrombolytic Intracranial hemorrhagic transformation were 21.4%, 37.9%, no significant difference between two groups(P> 0.05). But 3-4.5h group after thrombolytic risk of symptomatic intracranial hemorrhage 20.7% was significantly higher than the 3.5% 0-3h group, the difference was statistically significant(P <0.05). After intravenous thrombolysis within 90 d deaths were 14.3%, 24.1%, there was no significant difference(P> 0.05).Conclusion:1. Atrial Fibrillation Patients with Ischemic Stroke rt-PA intravenous thrombolysis is safe and effective.2. Atrial fibrillation patients with cerebral infarction intravenous thrombolytic 90 d poor prognosis group than those without atrial fibrillation, increase the risk of intracranial hemorrhage, but does not affect mortality.3. Atrial fibrillation patients with cerebral infarction intravenous thrombolysis within 3h safe and effective.4. Atrial fibrillation patients with cerebral infarction may benefit from early thrombolysis 3-4.5h, but long-term effect is not obvious thrombolysis and symptomatic intracranial hemorrhage risk. |
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