Study On The Prognosis Of Intravenous Thrombolysis In Mild Stroke

Objective In this study,a case-control study was conducted on mild stroke within 3hours of onset(NIHSS score?5 on admission).The safety and short-term and long-term prognosis of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)and aspirin combined with clopidogrel double antiplatelet therapy in patients with mild stroke were compared.Intravenous thrombolysis of(AIS)in patients with acute ischemic stroke has a history of about 20 years.However,due to its indications,contraindications and complications,the rate of intravenous thrombolysis is not high,and the thrombolytic rate of mild stroke is even lower.The traditional view is that mild stroke symptoms and good prognosis do not require intravenous thrombolytic therapy,and thrombolytic therapy may cause intracranial hemorrhage and bring more serious disease hazards to patients in the past,so in the past,there is no need for intravenous thrombolytic therapy to cause intracranial hemorrhage.Mild stroke has not been used as an indication of intravenous thrombolysis in rt-PA.American guidelines in 2010 also indicated that patients with a NIHSS score of less than 4 were not treated with thrombolytic therapy.But in recent years,a large number of studies have shown that light Some 29% of patients had poor prognosis,15% of them had increased disability or death,and intravenous thrombolysis did not increase the risk of intracranial hemorrhage in mild stroke.In 2013,the American Heart Association(AHA)and Stroke Center(ASA)published guidelines for early management of patients with acute ischemic stroke,referring to assessing the potential risk and potential benefits of intravenous thrombolysis in patients with mild stroke.< guidelines for diagnosis and treatment of Acute Ischemic Stroke in China 2014 > it is pointed out that stroke with mild stroke and rapid improvement of symptoms is regarded as a relative contraindication of intravenous thrombolysis.In the past few years,most international and domestic guidelines,based on the CHANCE study by Professor Wang Yongjun of Tiantan Hospital,suggest that aspirin combined with clopidogrel is more effective than aspirin in the treatment of mild stroke and TIA patients within 24 hours of onset.It can also reduce the risk of stroke recurrence within 90 days without increasing the risk of bleeding,which proves the efficacy and safety of dual antiplatelet therapy for mild stroke which is regarded as a routine treatment in the acute stage of mild stroke.For patients with mild stroke who were admitted to hospital for 3 hours after onset,the choice of rt-PA intravenous thrombolysis or double antibody routine therapy,what is the rt-PA intravenous thrombolysis? advantage? Research is still under way.Methods In Chifeng Hospital of Inner Mongolia Medical University,there is a green channel of thrombolysis for acute cerebral infarction.104 patients with mild stroke were admitted to the Department of Neurology,Chifeng Hospital,Inner Mongolia Medical University,on July 10,2011 and August 12,2011,respectively.The onset time was within 3 hours,and mild stroke was defined as(NIHSS)? 5 in the National Institutes of Health Stroke scale.The patients were divided into thrombolytic group(n = 50)and control group(n = 54)according to whether their family members or patients agreed to rt-PA intravenous thrombolysis.In the thrombolytic group,24 hours after treatment,the patients with CT,without contraindication were treated with antiplatelet drugs.The control group was treated with antiplatelet drugs immediately after admission.At admission,24 hours after treatment,7 days after treatment,14 days after treatment,NIHSS scores were compared,and improved Ran Kin scores were compared with(m Rs)at 90 days after treatment to evaluate the safety,short-term and long-term prognosis of patients in thrombolytic group and control group.Results Baseline data of the two groups were age,sex,risk factors(hypertension,diabetes,coronary heart disease,hyperlipidemia,stroke history,smoking history,etc.),admission NIHSS score,admission systolic and diastolic blood pressure,The incidence and visit time were similar,the difference was not statistically significant(P > 0.05),the two groups were comparable.1.Safety: there were 2 cases of symptomatic intracranial hemorrhage in thrombolytic group and 1 case of symptomatic intracranial hemorrhage in control group(P = 0.513).2.Short-term prognosis:(1)24-hour treatment effective: thrombolysis group(28 cases),control group(17 cases)were effective,P=0.012,the difference was statistically significant;There were 32 cases in the thrombolysis group and 11 cases in the control group,the difference was statistically significant.(2)the symptoms of the thrombolytic group were obviously improved in 24 hours: 13 cases in the thrombolytic group were obviously better than those in the control group(P= 0.000).In the control group,there was a significant improvement in symptoms(P=0.000),and there was a significant difference between the two groups.The symptoms of the thrombolytic group were improved in 15 cases and in the control group in 1 case.The difference was statistically significant(P= 0.000).3.Long-term prognosis: 41 cases of thrombolysis group had a good prognosis at 90 days,26 cases of control group had a good prognosis on 90 days,P=0.000,the difference was statistically significant.Conclusion1.Mild stroke venous thrombolytic therapy does not increase the occurrence of intracranial hemorrhage.2.Intravenous thrombolytic therapy of mild stroke can increase the effective rate of treatment and the obvious improvement rate of symptoms,and reduce the neurological disability for 90 days.