Comparison Of Therapeutic Effects Of Intravenous Thrombolysis With Reteplase And Alteplase On Cerebral Infarction And Influencing Factors Analysis

Objective: To compare the efficacy of intravenous thrombolysis with Reteplase and Alteplase and the risk factors that may affect the efficacy of intravenous thrombolysis.METHODS: A total of 74 patients diagnosed with cerebral infarction diagnosed and agreed to receive thrombolytic therapy from the Department of Neurology at the Second People’s Hospital of Yueyang City from 2016 to 2017 were collected.Of these,44 patients were intravenously thrombolyzed with reteplase and 30 patients were given alteplase.All patients receiving thrombolytic therapy met the 2013AHA/ASA Guidelines for the Early Treatment of Acute Ischemic Stroke,the 2010 China Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke,and the Chinese Expert Consensus for Acute Ischemic Stroke Intravascular Treatment.All patients were recorded after admission for the patient’s gender,age,weight,height,laboratory test data,past history,onset-to-treatment time.And record NIHSS scores on admission,24 hours after treatment,and discharge;complete laboratory tests: coagulation,blood routine,blood glucose,blood lipids,liver and kidney function.The preparatory work was improved.After signing the agreement of the family members,intravenous thrombolysis was performed using alteplase or reteplase.The control group alteplase(manufactured by Boehringer Ingerheim in Germany,the product name is love Tong Li)was used as 0.9mg/kg,the maximum dose of 90 mg,adding100ml of normal saline,the first 10% will be intravenously,and the remaining 90% given continuous intravenous infusion for 1 hour.Observed group of reteplase(produced by Shandong Dong’e E-Gum Co.,Ltd.,trade name Rui Tong Li)at a dose of 0.9 mg/kg,with a total dose of no more than 54 mg,and a total amount of reteplase of 10 in physiological saline %,Intravenous bolus injection within 3 minutes,followed by intravenous infusion of the remaining 90% in 100 ml of normal saline within 1 hour.Record the time when the patient started and ended the intravenous thrombolytic therapy.Complete CT and MRI examination within 36 hours after thrombolysis and improve vascular examination if necessary.Within 2 hours after treatment,blood pressure was measured every 15 minutes.Results: 1.There was no significant difference in baseline data(age,systolic blood pressure,diastolic blood pressure,hemoglobin,platelet,blood lipids,blood glucose,liver and kidney function)between the two groups before thrombolysis(P > 0.05).2.There was no significant difference in coagulation function(including APTT,TT,PT,FIB,INR)before thrombolysis between the two groups;there was a significant difference in prothrombin time(PT)after thrombolysis(P< 0.05),other comparisons were not statistically significant.3.The difference in the incidence of bleeding between the two groups was not statistically significant.4.Using the ROC curve to compare the effects of five scoring systems to predict the risk of hemorrhage after thrombolysis.The area under the MSS scoring system(AUC)was 0.545,the AUC of the HAT system was 0.671,the SEDC scoring system AUC was 0.548,the GRASPS system AUC was 0.553,and the SITS system score was 0.625.5.Comparison of efficacy between the two groups,NIHSS at 24 hoursafter thrombolysis and at hospital discharge was lower than that at hospital admission.The difference in NIHSS between the two groups was statistically significant,and the reteplase group decreased significantly.After grouped by clinical efficacy,comparing the two groups,the difference was statistically significant(P<0.05).6.The NIHSS score after thrombolysis was reduced by >18%,ie,the clinical efficacy was improved,markedly improved,and recovered as the dependent variable.Take gender,age,history of hypertension,history of diabetes,history of heart disease,history of stroke,history of taking antihypertensive drugs,smoking history,drinking history,and OTT as independent variables.Do a single factor correlation analysis of the two.The thrombolytic efficacy in the reteplase group was negatively correlated with the history of hypertension,the history of diabetes,the history of CHD,the history of smoking,and the duration of thrombolysis.The efficacy of the alteplase group was inversely related to the history of CHD,the history of taking antihypertensive drugs,and OTT.Conclusions: 1.Both reteplase and alteplase are effective in the treatment of acute ischemic stroke,and the efficacy of reteplase may be better than that of alteplase.2.HAT,SEDAN,GRASPS,MSS,SITS can be used to assess the risk of hemorrhage after thrombolysis,and HAT prediction ability is better.3.History of hypertension,history of diabetes,history of smoking,and OTT may be the influencing factors for the efficacy of reteplase.