| Objective: large area cerebral infarction of acute onset,rapid progression,disability and mortality rate were higher and the prognosis is poor.Thrombolytic therapy is an effective therapy recognized at home and abroad,but the study simply observe the effect of intravenous thrombolytic therapy of massive cerebral infarction is not much.This research through the observation in patients with large area cerebral infarction and the effectiveness and safety of intravenous thrombolysis,further understanding of the different subtypes of cerebral infarction patients the effect of intravenous thrombolytic therapy and to provide reference evidence for clinical.Methods: collected in October 2010 to October 2015 admitted to 221 cases of Dalian Medical University First Affiliated Hospital neurology intensive section of large area cerebral infarction patients,all patients with large area cerebral infarction [1],and by brain imaging studies(MRI or CT scans to check a clear diagnosis of large area cerebral infarction.Record all patients’ age and sex,previous history of conventional data.According to whether they received intravenous thrombolysis with RT PA in the patients were divided into thrombolysis group and control group,the control group only application of anti platelet aggregation and blood lipid and other conventional treatment,thrombolysis group in the conventional treatment based on be RT PA intravenous thrombolytic therapy of 0.9 mg / kg,after 24 hours without bleeding,giving anti platelet aggregation therapy.The baseline clinical data were recorded in two groups of patients before and after treatment,24 h,7d,NIHSS score,GCS score,90 d after treatment,m RSscore,and intracranial hemorrhagic transformation,substantial cerebral hemorrhage and death.Also on admission whether coma or accompanied by atrial fibrillation thrombolytic therapy group and control group were divided into different subgroups according to were recorded accompanied by coma of large area cerebral infarction patients with thrombolytic therapy group and control group before treatment and after treatment for 24 h,7 d GCS score,90 days after treatment of Mrs score were recorded with atrial fibrillation of large area cerebral infarction thrombolysis group and control treatment group before treatment and after 24 hours and 7 days of NIHSS score,treatment after 90 d of Mrs score.Results:1.This study collected a total of 221 cases of large area cerebral infarction patients and in thrombolytic group a total of 109 cases,68 cases of male patients,41 cases of female patients,age between 40-90 years old,average 68.76 + 10.59 years,there were 112 cases in the control group,63 cases of the male,female,49,age between the age of36-95,average 69.51 + 14.66 years old.Two groups of baseline clinical data,including gender,age,SBP/DBP before the treatment,no significant medical history,admission NIHSS score,admission GCS score difference(p > 0.05).2.Thrombolytic therapy group and control group in the treatment of NIHSS scores were compared with those before treatment decreased,but thrombolysis group NIHSS score significantly reduced,and the difference is statistically significant(p < 0.001);thrombolytic therapy group and control group after the Glasgow Coma Scale(GCS)were compared with those before treatment increased,but thrombolysis group GCS score increased by a large margin,the difference has statistical significance(p < 0.001).Thrombolytic therapy group 3 months after Mrs score 2.17 + 1.201 compared with control + 3.19 groups 1.674 low,the difference was statistically significant(p < 0.001),but the prognosis of thrombolysis group good(MRS score less than or equal to 1)of patients with 26 cases(23.85%)than in the control group(n = 17)(15.18%),the difference was not statistically significant(p > 0.05).3.After the treatment of thrombolysis group 18 cases(16.51%)of intracranial hemorrhagic transformation,5 cases(4.59%)substantive cerebral hemorrhage and 24 cases in the control group(21.43%)of intracranial hemorrhagic transformation,12(10.71%)substantive cerebral hemorrhage differences had no statistical significance(p > 0.05).4.90 d after treatment of thrombolysis group and 18 cases died(16.51%)and the control group of 20 cases of death(17.86%),the difference was not statistically significant(p > 0.05).The NIHSS score increased by comparing baseline data suggest that increased the risk of death.5.Admission coma of large area cerebral infarction patients with thrombolytic therapy group and control group in the treatment of 24 h,1D GCS score were compared with those before treatment increased,but the difference between the two groups no significant(p > 0.05),3 months after treatment the Mrs score thrombolysis group 3.42 +0.793 compared to the control group 4.44 + 133.8 low,difference has statistical significance(p < 0.05),but the prognosis in thrombolysis group good(MRS score less than or equal to 1)of patients with cases(0.00%)than in the control group(n = 1)(5.56%),the difference was not statistically significant(p > 0.05).6.Patients with atrial fibrillation area in patients with cerebral infarction thrombolytic therapy group after 24 h,1D NIHSS score were compared with those before treatment decreased,in treatment group and control group after 24 h,1D NIHSS scores were compared with those before treatment increased,the difference between the two groups has statistical significance(p < 0.05)and Mrs scores after 3 months treatment,thrombolysis group(3.42 + 0.793 compared to the control group 4.44 + 133.8 low,the difference was not statistically significant(p > 0.05),and the prognosis of thrombolysis group good(MRS score less than or equal to 1)of patients with cases(0.00%)than in the control group(n = 1)(5.56%).The difference was also not statistically significant(P > 0.05).Conclusion:1.Large area cerebral infarction in patients with rt-PA intravenous thrombolytic therapy can not only benefit early,but also can significantly improve the long-term prognosis,but the proportion of patients with good prognosis did not increase,it is still difficult to make patients recover completely.2.Large area cerebral infarction in patients with rt-PA intravenous thrombolytic therapy did not increase the risk of intracranial hemorrhage,and does not affect mortality,no obvious adverse reaction,safe.3.Rt-PA intravenous thrombolysis treatment compared with conventional treatment on admission to the hospital coma patients with a large area of cerebral infarction patients,although there was no significant benefit,but can improve long-term prognosis.4.Rt-PA intravenous thrombolytic therapy can improve the short-term prognosis of patients with atrial fibrillation with a large area of cerebral infarction,but the long-term effect is not obvious. |
