| Objectives Rt-PA intravenous thrombolysis in acute ischemic stroke: a clinical study of176 casesMethods To collect and analyze the 176 cases of the Affiliated Hospital of North China University of science and technology from April 2013 to March 2016, and to accept the standard of intravenous thrombolysis. Clinical data of patients with acute ischemic stroke after intravenous thrombolysis with rt-PA. The time window of the anterior circulation was within4.5 hours, and the time window of the posterior circulation was within 6 hours. Analysis of the characteristics of the cases, the baseline data of collected from patients with age, sex,hypertension, coronary heart disease, diabetes, atrial fibrillation, smoking history, as well as the onset to treatment time( onset to treatment time; OTT) data, and the process of thrombolysis in patients blood pressure variability and blood sugar variation Treatment method using rt-PA intravenous thrombolysis treatment, the dose of 0.9mg/kg(maximum individual dose not more than 90mg), the first 1 of the dose within 10% minutes,the rest of the dose in about 60 minutes, continuous intravenous infusion.According to rt-PA before and after intravenous thrombolysis, clinical symptoms,evaluation of clinical efficacy of intravenous thrombolysis, the application of NIHSS score and Mrs score can objectively reflect the changes in the disease, can be evaluated in the short-term prognosis after thrombolysis and long-term prognosis. Better prognosis and standard: recent validity index is NIHSS score decreased more than 4 points or NIHSS reduced to 0; good longterm prognosis indicators including MRS in 2 and below. Note on day 1, 3 days, 5 days, on the7 th day of NIHSS assessment data, and tracing the NIHSS score, and recorded at the time of admission and discharged after 3 months and 6 months of Mrs score to evaluate the prognosis of patients with RT PA intravenous thrombolysis. According to the collected Mrs score were divided into prognosis group(MRS score = 2 points) and good prognosis group(MRS score <2).According to intracranial hemorrhage transformation and evaluation of RT PA intravenous thrombolysis safety. According to the CT images that hemorrhage and neurological injury aggravated( NIHSS is larger than or equal to 4 points), intracranial hemorrhage is converted in HI1, HI2, PH1 PH2.The experimental data were treated with SPSS17.0 software for statistical analysis,measurement data used and the mean and standard deviation, using t test and single factor variance analysis, P < 0.05 for statistical significance. Using binary logistic multivariate analysis method for analysis of effects of thrombolytic therapy is effective, safety factors.Results In April 2013 to 2016 March received in our hospital accepted RT PA intravenous thrombolytic therapy in patients with average(67.63±12.4) years old, male person 108( 63.4%), smoking history cases 84( 47.7%), before thrombolysis NIHSS score( 13.77±4.25), risk factors for hypertension cases 108( 63.4%), diabetic patients 44(25%), atrial fibrillation 67(38.2%),coronary heart disease 45(25.6%).Good prognosis group cases, Ott average minutes, the rate of blood pressure variation in the process of thrombolysis, blood glucose variability; prognosis group of cases, Ott average minutes, the rate of blood pressure variation in the process of thrombolysis, blood glucose variability. According to the NIHSS score early evaluation of thrombolytic efficiency,according to the Mrs score in the evaluation of prognosis, the prognosis of three months good(cases).In the collected cases, intracranial hemorrhage was converted to 9%, HI1( 3), HI2(4), PH1(6), PH2(3). Among the 3 patients with good prognosis group(9), HI11 cases, HI2 1 cases, poor prognosis group(7), HI1 1 cases,HI2 1 cases PH1 2 cases, PH23 cases.Conclusions 1. In 4.5 hours time window, rt-PA intravenous thrombolysis treatment of acute ischemic stroke is effective.Univariate analysis showed a history of TIA, bleeding and transformation, blood pressure variability, blood glucose variability, NIHSS score before thrombolysis, Ott time, hypertension,and diabetes were risk factors for prognosis. Multivariate regression analysis showed that blood pressure variability, blood glucose variability and OTT time were independent risk factors for poor outcome after recent and long-term thrombolysis.According to the data analysis, it was found that hypertension, diabetes mellitus, atrial fibrillation, blood glucose variability, blood pressure variability, and OTT time were the risk factors of intracranial hemorrhage, Multi factor regression analysis is an independent risk factor for hypertension, blood pressure variability, atrial fibrillation is an independent risk factor for intracranial hemorrhage; the long-term prognosis of p H2 patients in this study is relatively small, so rt-PA intravenous thrombolytic therapy is relatively safe. |
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