| Objective: 1.To investigate the short and long-term effects of intravenousthrombolysis with recombinant tissue type plasminogen activator(rt-PA)for acute mild ischemic stroke.2.To investigate the safety of intravenous thrombolysis with rt-PA for acute mild ischemic stroke.3.To investigate the effects and safety of the different TOAST etiology subtypes,different OTT(onset to treatment time)times,different ages and different baseline NIH scores for acute mild ischemic stroke.Methods: Our study collected 166 acute mild ischemic stroke patients from the neurology department of our hospital 2016.1-2017.9.According to whether or not to accept rt-PA intravenous thrombolysis therapy after the onset of disease,these patients were divided into two groups:thrombolysis group(83 cases)and control group(83cases).The Nation Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(m RS)were used to evaluate short and long-term therapeutic effects of the thrombolysis group and the control group;the incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage after thrombolysis were observed in the two groups.And the patients in the two groups were divided by TOAST etiology subtype.Short and long-term therapeutic effects and the incidence of intracranial hemorrhage of them were compared.We now divide the thrombolysis group into the different subgroups.According to the time of onset to treatment(onset to treatment,OTT)they are 0 to 3 h and 3-4.5 h.According to the ages,they are < 80 years old and ≥80 years old.According to the baseline NIHSS scores,they are 0 to 3 points and 4 to 5 points.And we will compare three aspects of its short and long-term therapeutic effects and the incidence of intracranial hemorrhage in the following-up work.Results:1.Baseline materials in both groups are similar in age,sex and past medical history.After the onset of disease,the differences of baseline NIHSS scores,the blood pressure and onset time have no statistical significance but have comparability.2.The NIHSS scores of thrombolysis group of 24 h and 7d after thrombolysis were obviously lower than the baseline NIHSS scores.While in the control group only 7d-NIHSS scores are significantly lower than the baseline NIHSS scores.Meanwhile,24 hours after treatment,the NIHSS scores of patients in the controlgroup were higher than the baseline.After treatment,at every time point(24 h,7 d),the efficient of thrombolysis group was higher than that of the control group.The deterioration rate of early nerve function in thrombolysis group was 7.2%,which was far lower than that in the control group(25.3%).In the long-term prognosis,85.5%patients in mild stroke thrombolysis group gained long-term good prognosis,while that in the control group was 71.1%.The above differences were statistically significant.At the recurrence rate,the recurrence rate of thrombolysis group within 90 d was 8.4%,while that of control group was 10.8%.The recurrence rate of control group was higher than that of thrombolysis group,but the differences between the two groups have no statistical significance(8.4% vs 10.8%,χ2=0.277,P=0.599,OR=0.757,95%CI 0.268~2.136).3.For mild strokes,Rt-PA intravenous thrombolysis therapy is safe,without increasing the risk of intracranial hemorrhage,symptomatic intracranial hemorrhage and mortality.In the 166 mild stroke patients,the incidence of intracranial hemorrhage was 3.6%.Thrombolysis group was 6.0%,while the control group was6.0%.The differences between both have no statistical significance(χ2=2.767,P=0.096,OR=5.256,95%CI 0.601~46.005).There was no symptomatic intracranial hemorrhage in two groups.Meanwhile,there was no death in two groups during hospitalization and 90 d follow-up visit.4.The two groups were divided into 4 groups according to the different types of TOAST.They were artery atherosclerosis(LAA)subtype 73 cases of type,cardiac embolism(CE)subtype,28 cases,small artery occlusion(SAO)subtype,51 cases,other reasons(SUE)and unknown causes(SOE)subtype,a total of 14 cases.In the treatment of 7d and 90 d good prognosis rate,the LAA subtypes of thrombolytic group were better than those in the control group,and the differences were statistically significant.(83.3% vs 40.5%,P<0.001;88.9% vs 67.6%,P=0.028).The 7d efficency of SAO thrombolysis subgroup was higher than that of the control subgroup,and differences were statistically significant(76.0% vs 36.8%,P=0.001).However,there was no obvious difference in the good prognosis of 90 d.There was no obvious benefit in the treatment of other subtypes.5.Patients in thrombolytic group were divided into two thrombolytic time subgroups according to onset to treatment(OTT),including 37 cases in 0-3h subgroup and 36 cases in 3-4.5h subgroup.The 7d effciency of 0 to 3 h subgroup is a little higher than that of 3-4.5 h subgroup,and there was no statistically significant difference(78.7% vs 69.4%,P=0.335).In the 90 days of good prognosis,the 90-day prognosis rate of 0-3h subgroup was 95.7%,higher than that of the 3-4.5h subgroup(77.8%),and the difference was statistically significant(P=0.013).The incidence of intracranial hemorrhage had no significant difference(5.4% vs 6.5% P=0.734).6.The patients in the thrombolytic group were divided into two groups of age group according to age group,including 71 cases in the subgroup of <80 and 12 in the group of ≥80 years.The effective rate of 7d and good prognosis rate of 90 d in the< 80 years subgroup was higher than that of the ≥80 years subgroup,and the difference was statistically significant.The incidence of intracranial hemorrhage had no significant difference(5.6% vs 8.3% P=0.873).7.The patients in the thrombolytic group were divided into two subgroups according to the baseline NIHSS score: 70 in the 0-3 subgroup,and 13 in the 4-5subgroup.In the 0-3 subgroup,the effective rate was 71.4%,and the 4-5 subgroup was 92.3%,and the difference was not statistically significant.There was no significant difference between the two groups in the 90 days of good prognosis and the incidence of intracranial hemorrhage(90%vs76.9% P=0.183;5.7%vs7.7%P=0.994).Conclusions:1.For patients with acute mild ischemic stroke,intravenous thrombolytic therapy by rt—PA within 4.5 h may contribute to a greatly improvement in a short and long time.And reduce the incidence of early neurologic deterioration.But the recurrence rate was not falling.Thrombolytic therapy did not increase the risk of intracranial hemorrhage and symptomatic intracranial hemorrhage.2.For patients with light stroke with different TOAST scores,intravenous thrombolysis of large atherosclerotic light stroke patients is more beneficial,which can improve short-term efficacy and improve long-term prognosis.However,rt-paintravenous thrombolysis can only improve the early nerve function defect of small artery occlusion type,which has little effect on long-term prognosis.The thrombolysis of the type of light stroke patients did not benefit significantly.3.For patients with light stroke,the treatment of intravenous altipase was beneficial in 4.5 hours.However,rt-pa intravenous thrombolysis in 0-3 hours was more helpful to the long-term prognosis of patients with cerebral infarction compared with 3-4.5h subgroup.The treatment time window should be shortened to improve the curative effect.4.Compared with elderly patients,the thrombolysis of non-elderly patients with light stroke is more beneficial,and elderly patients should consider the risk benefit ratio of thrombolytic therapy.5.There was no difference in thrombolytic therapy for patients with different baseline NIHSS scores. |
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