| Objective:To evaluate the efficacy and safety of intravenous alteplase in the treatment of mild stroke.To explore the effect of thrombolytic therapy on functional prognosis under different baseline characteristics.To explore the outcome of thrombolytic intervention for disabled and non-disabled minor stroke.Methods:203 cases of minor stroke patients admitted to the First Hospital of Shanxi Medical University from January of 2014 to February of 2018,104 patients received rt-PA intravenous thrombolysis(intravenous thrombolysis group),99 patients were not treated with intravenous thrombolysis(non-thrombolysis group).The outcomes of the two groups were analyzed by using the reduction of National Institutes of Health Stroke Scale(NIHSS)score and discharge home,which as short-term prognostic indicators,and the modified Rankin scale(mRS)score at 3 months as long-term prognostic indicators.The incidence of symptomatic intracranial hemorrhage(sICH)was compared between the two groups.To investigate the relationship between different treatment methods and prognosis according to different baseline characteristics.According to the classification of disability of acute symptoms,the correlation between different treatment methods and prognosis was analyzed.After adjusting for confounders(including gender,age,blood glucose at admission,weight,length of stay),OR and 95% CI of each variable were calculated.Results:1.The two groups were similar in age,gender,time between the onset and treatment,smoking and drinking,and there was no statistical difference.The difference was that the average blood glucose level and limb weakness with sensory disorders were higher in the thrombolytic group than in the non-thrombolytic group(6.15mmo/l vs 5.10mmo/l,P=0.003).20.2% vs 9.1%,P=0.026).Previous cases of oral anticoagulants and acute limb sensory disorders in the non-thrombolytic group were more than those in the thrombolytic group(7.1% vs 1.0%,P=0.025,respectively).12.1% vs 1%,P=0.001).Based on the differences in baseline characteristics between the two groups,confounders should be adjusted for subsequent observation of efficacy.2.The reduction of NIHSS score in the thrombolytic group(88.5% vs 65.7%,P=0.001)and the rate of discharge home(91.3% vs 74.7%,P=0.002)were both higher than that in the non-thrombolytic group.3.There was no significant difference in mRS score between the two groups at3 months(mRS 0-1:85.6% vs 78.8%;mRS>1:14.4% vs 21.2%,P = 0.206).4.Symptomatic intracranial hemorrhage occurred in 4 of 203 patients,3 in the thrombolytic group(2.9%)and 1 in the non-thrombolytic group(1%).There was no statistical difference between the two groups in sICH(2.9% vs 1%,P=0.649).There were no thrombolytic-related deaths in either group.5.For patients with previous history of hypertension,long-term smoking history and 5points of baseline NIHSS within 3 hours of onset,the rate of discharge home in the thrombolytic group was higher than that in the non-thrombolytic group(P < 0.005).6.For patients with disabling symptoms at admission,the rate of discharge home in the thrombolytic group was higher than that in the non-thrombolytic group[84.9% vs 60.0%,OR=3.750,95%CI(1.436,9.792),P=0.007;after adjustment,OR=7.227,95%CI(2.049,25.494),P=0.002].Conclusion:Intravenous thrombolysis for mild stroke is effective and safe.Patients with mild stroke who had a history of hypertension,a history of long-term smoking,a 5 point baseline NIHSS score,and disability at admission had greater benefit from intravenous thrombolysis. |
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