The Clinical Observation On The Treatment Of Mild Acute Ischemic Stroke With Rt-PA Intravenous Thrombolysis And Double Antipathy

Objective: To establish evidence that thrombolysis is the most effective treatment for acute cerebral infarction.However,many patients with acute cerebral infarction who arrived at the hospital without thrombolytic therapy due to various reasons.The thrombolysis rate of light stroke were lower.In the clinical work,it is generally believed that the prognosis of patients with light stroke was good and that thrombolysis had a certain risk of bleeding.The 2014 guidelines require NIHSS to recommend thrombolytic therapy before it was recommended.Subsequent studies had found that the prognosis in light pawns were not as good as predicted,with about 25% of light pawns deteriorating and left with disabilities.Subsequent U.S.guidelines expanded the scope beyond NIHSS scores to require that intravenous thrombolytic therapy be performed with measurable neurological defects.Meanwhile,the results of the 2013 CHANCE study leded by Professor Wang Zhoujun of the Temple of Heaven Hospital showed that,TIA or light for 24 hours In patients with TIA or light stroke treated within 24 hours of onset,clopidogrel combined with aspirin enterolysis tablets were more effective in reducing the incidence of initial stroke in 90 d without increasing the risk of bleeding.Light stroke,active thrombolysis or only given double anti-therapy,the results of the better,how to choose the treatment,there is no basis,at present large-scale clinical randomized double blind control study is less evidence.In order to better guide clinicians in treating patients with acute ischemic mild stroke,this study was conducted to observe whether the effectiveness of rt-pa,a recombinant plasminogen activator,in preventing stroke progression and recurrence was different from that of double antiplatelet(aspirin + clopidogrel)in patients with acute ischemic mild stroke within 3 H and 3-4.5 hours.Method: All patients with acute ischemic mild stroke(NIHSS worth 5 points,onset time < 3 hours and 3-4.5 hours)were admitted to the Department of Neurology of Cangzhou Central Hospital.All patients were treated with the diagnostic criteria for ischemic cerebrovascular disease established in the Chinese Guidelines for the Treatment of Acute Ischemic Stroke 2014.And the head CT and head MRI+DWI were confirmed as acute ischemic stroke,and the head and neck CTA+ neck vascular color Doppler ultrasound and echocardiography were used to clarify the causes and pathogenesis.There were 182 cases,which were divided into two groups(A1,A2,B1,B2)according to the time of onset(within 3 H,between 3 H and 3-4.5 H): 90 cases in group A and B;92 cases in group B;and then two subgroups(A1,A2,B1 and B2)according to the different treatment methods(rt-PA intravenous thrombolysis and double antiplatelet).Group A1 and B1: Rt-PA was given by intravenous administration of 0.9 mg/kg,24 H was later confirmed as non-hemorrhagic by CT in the skull,100 mg + clopidogrel 300 mg/d for first aspirin,100 mg + clopidogrel 75 mg for second time,21 MG,and then 100 mg of aspirin enterolysis tablets.Group A2 and B2: clopidogrel(first day dose 300 mg/d);From the following day 75 mg/d)combined with aspirin(100 mg/d)for 21 days;Aspirin enteric tablets were then given 100 mg;After 3 hours and 3-4.5 hours respectively,the neurofunctional defect score(NIHSS)and the modified Rankin scale score and total efficiency evaluation were performed in 90 D of 3 H,24 H,7 D and 14 D treatment methods.Results:The general data of age,sex,risk factors(including hypertension,diabetes,hyperlipidemia,smoking history,history of stroke,coronary heart disease)among the different groups were not statistically different(P > 0.05).In patients with acute stroke within 3 hours,the NIHSS score of A1 and A2 groups decreased significantly before treatment(P<0.05),while the NIHSS score of 3h,24 h,7D and 14 d groups were significantly different(P <0.05);The scores of the modified Rankin scale were 1.12 ± 0.75 and 1.88 ± 0.97 in 90 d,respectively.There were statistically significant differences between the two groups(P<0.05),and the total efficiency was 81.39 % and 63.83 % respectively.In 3-4.5 hours,NIHSS scores were significantly lower in patients with acute stroke,and in the patients with B1 and B2 treatment(P< 0.05),but no difference was found in the patients with 3H,24 H,7D and 14 D respectively(P >0.05).The scores of the improved Rankin scale were 1.62 ± 0.73 and 1.97 ±0.88 in 90 d,respectively.There was no significant difference(P>0.05)between the two groups and no significant difference(P>0.05)in overall efficiency(73.33 % and 65.96 %,respectively).Conclusion:1.The time of onset within 3 hours of acute stroke patients,intravenous thrombolysis and rt-PA dual antiplatelet therapy is clinical effect,but intravenous thrombolytic treatment NIHSS score decreased more,indicating that rt-PA thrombolytic therapy has better clinical effect and therefore recommended within 3 hours of acute cerebral stroke patients with intravenous thrombolytic therapy.2.The onset time between 3-4.5 hours of acute stroke patients,the clinical curative effect of intravenous thrombolysis and rt-PA double antibody treatment is basically the same,and the safety is the same,so for 3-4.5 hours between patients should choose intravenous thrombolysis or dual antiplatelet therapy according to the patients' situation assessment.