Analysis Of Clinical Curative Effect Of Thrombolytic Therapy For Acute Cerebral Circulation Infarction By IV Rt-PA

Objective:To investigate the efficacy and the risk of thrombolysis withintravenous recombinant tissue plasminogen activator (rt-PA) in patients with acutecerebral infarction.Methods:101patients of acute cerebral infarction with an onset within4.5h hoursare divided into thrombolysis group and the control group according to whether canaccept fibrinolytic therapy, thrombolysis group receive routine therapy of rt-PA of0.9mg.kg-1,and give antiplatelet therapy if no bleeding after24h; The control groupreceive just antiplatelet therapy；Both of two groups also review head CT after24h; Allof the patients have to do the basic material records, The two groups of before treatmentand after treatment within24h and7d accept NIHSS respectively, and Watch and recordcomplications such as the cerebral hemorrhage, death,and pneumonia. according toinfarction area, early ischemia of the hospital and imaging studies，patients will bechanged for subtype, To assess curative effect with Stroke Scale (NIHSS) neurological scoring，Thebasic data for the every subgroup such as the method of treatment、time of infarction、infarctionarea, early ischemia and NIHSS scores, curative effect, hemorrhage, death and other data is statisticallyanalyzed.Experimental data was analysed by the software of SPSS17.0, T-test was used if Measuringmaterial correspond normal distribution，and Rank and inspection if not, chi-square test was used in theCount data comparison, the differences have a statistical significance if P <0.05.Results:1. The efficacy and safety of Fibrinolytic therapy：To compare NIHSS scoresamong the treatment of early24h and later24h and7d in the thrombolysis fibrinolytictherapy of51cases patients, it can improve the NIHSS scores after fibrinolytic therapy,and It has statistically significant comparing with the control group, the NIHSS scores isimproved in the thrombolysis group, The difference was statistically significant comparing Thrombolysis group with control group in effects, Fibrinolytic therapy canimprove the ischemic stroke patients with neural function defect, it is more significantthan a common treatment in efficacy, Thrombolysis group has8cases of bleeding and2cases of substantial bleeding and4cases of hemorrhagic infarction and2cases of skinmucosal bleeding, It has a statistical significance than control group in the increasedrisk of bleeding, But substantial bleeding and intracranial bleeding have no difference,Thrombolysis group has7cases of death and the control group has7cases of death,it isno statistical difference between them. comparing the baseline data, it mean that thehigher NIHSS scores,the more risk of death.2.The effect and safety of Different time window: NIHSS score can be improvedsignificantly after24h、7d treatment of Thrombolysis group3h and3to4.5h timewindow, and3h treatment have a significant recovery. It has no statisticallysignificant between3h and3to4.5h group.3h group has3cases of hemorrhage,and1case of substantial bleeding and2cases of skin mucosal bleeding,3to4.5h group has5cases of bleeding and1case of substantial bleeding and4cases of hemorrhagicinfarction. It has increased the risk of Intracranial bleeding comparing3to4.5h group to3h group in the thrombolysis,3h group has4cases of death and3to4.5h has3casesof death, it has no statistical difference between them.3. The effect and safety of different infarction area：It was not statisticallysignificant differences that comparing the Curative effect of Pumping blood areainfarction which is more than a third with that whicn is lower than a third andVertebrobasilar artery infarction of the system. The Pumping blood area infarctionwhich is more than a third is rea not affect curative effect. Two cases of substantialbleeding whicih is Internal carotid artery system are the patient whose Pumping bloodarea infarction is more than a third, Five cases of substantial bleeding whicih is morethan a third and one case of substantial bleeding whicih is lower than a third. Thepatients of Pumping blood area infarction which is more than a third are More easily tointracranial bleeding than that of Vertebrobasilar artery infarction, and the mortality ofthe patient whose Pumping blood area infarction is more than a third is higher than thatwhich is lower than a third.4. The effect and safety of change of large area in the early ischemic imaging：Tocompare patients with early ischemic changes which is more than third MCA or not,butthe later Infarction area is more than third MCA which has been confirmed, We foundno significant difference in curative effect, and the risk of intracranial bleeding and death yet; To compare patients with early ischemic changes which is more than thirdMCA and Control group，we Found that the former can greatly improve prognosis，which has a statistical significance; but intracranial bleeding and mortality were not significantlydifferent.5. The situation of Pneumonia improved: compared thrombolysis group withtreatment group of incidence of pneumonia, we found that fibrinolytic therapy cansignificantly reduce the incidence of pneumonia patients.Conclusions：1. Using IV rt-PA in ultra-acute ischemic stroke may have a good effect at ourstudy.2. In3h thrombolysis group, intravenous thrombolysis with rt-PA is effective onthe treatment of acute cerebral infarction And the small sample of3-4.5h group also hasgood result Subtype analysis,which is relatively safe without increasing badcmplications.3. It can give a good curative efficacy when the ction area of MCA is greater thanA third in atients with acute cerebral infarction. But may increase intracranial bleedingand the risk of death.4. The patients with cerebral infarction can benefit from treatment of thrombolysiswhen the early ischemic brain tissue change more than a third of the MCA, and do notincrease the risk of fibrinolytic therapy, But for this type of patients with thrombolysisrequires careful, It must have a comprehensive judgment to the disease prognosis andwith the family sufficient communication may only be implemented.5. The patients of Ischemic cerebral infarction with fibrinolytic therapy can reduce theincidence of complications pneumonia.