Analysis Of Therapeutic Effect In The Treatment Of Acute Cerebral Infarction By Ⅳ Recombinant Tissue Plasminogen Activator

ObjectiveTo investigate the incidence of 4.5h in patients with acute cerebral infarction using rt-p A intravenous thrombolytic efficacy and risk of bleeding and death; at the same time comparison in the pathogenesis of 3h and 3-4.5h two different time windows for clinical efficacy of thrombolytic therapy and the risk of bleeding and death. MethodsRetrospective analysis of 258 cases of patients with acute cerebral infarction onset within the 4.5h,there are intravenous thrombolytic therapy for venous thrombolytic therapy group(referred to as thrombolytic therapy group),in the same period were within 4.5 hours of the onset of but not in patients with acute cerebral infarction thrombolytic therapy as control group.Thrombolytic therapy group with 196 cases in the treatment of patients with as soon as possible after intravenous administration of rt-PA(Boehringer Ingelheim Gmb H) treatment, according to 0.9mg kg-1(the amount of not more than 90mg) dose, while giving conventional treatment of the cerebral infarction(in addition to antiplatelet therapy), 24 h CT/ MRA scan, as confirmed no bleeding, and then given Aspirin 100mg/d treatment; 62 cases in the control group using aspirin 100mg/d and other conventional treatment of cerebral infarction,treatment of 24 h after CT/MRA scan.All patients of two groups were 3 NIHSS scores,respectively, before treatment,24 hours after treatment and after treatment for 7 days at three time points;observe the patients have no hemorrhage and hemorrhage, volume and so on.Determine the efficacy of standardsin accordance with the 1995 version of "Chinese stroke patients clinical efficacy evaluation standards".According to the time of cerebral infarction and treatment methods of each packet data analysis were compared,NIHSS score,clinical efficacy,bleedingand death.The results using SPSS17.0 software for statistics. Results1.Comparison of NIHSS score and efficacy before and after thrombolytictherapy :In patients treated with thrombolytic therapy group:196 cases patientswere intravenous thrombolytic therapy before and after the treatment, 24 h and7d after the NIHSS score, the comparison results show that the thrombolyticgroup patients in the intravenous thrombolytic treatment after the NIHSS scoreimproved significantly, and 62 cases of control group were compared,the differencewas statistically significant(P<0.05). Analysis of curative effect contrast display:thrombolysis group and better than the control group, the difference wasstatistically significant(P<0.05).2.Comparison of NIHSS score and efficacy of intravenous thrombolysis indifferent time window:NIHSS score 24 h after thrombolysis and 7d and NIHSSscore before thrombolysis compared to 3h within the time window of 115 cases ofacute cerebral infarction patients treated with intravenous thrombolysistherapy,improved significantly,the difference was statistically significant(P<0.05).3-4.5h the time window for thrombolytic therapy in 81 patients with acute cerebralinfarction in patients with NIHSS score and NIHSS score compared beforethrombolysis,also have improved significantly,the difference was statisticallysignificant(P<0.05). Curative effect:the 3h within the time window of thrombolysisin patients with efficiency of 83.4%,3-4.5h the time window of thrombolysiseffective rate was 80.2%,the clinical effect between two different time window forhrombolytic therapy,no significant difference(P> 0.05).3.Thrombolytic therapy group and control group bleeding contrast:Controlgroup 4 cases of hemorrhagic infarction,no substantive cerebral hemorrhage andmucocutaneous bleeding,thrombolysis group there were 19 cases of hemorrhage,including 6 cases of brain hemorrhage,9 cases of hemorrhagic infarction, and 4cases of skin and mucosa hemorrhage;total body hemorrhage the balance of risks ofthrombolytic group than in the control group(P<0.05),but increased the risk ofintracranial hemorrhage contrast, differences between the two groups showed nostatistical significance(P>0.05).4.Comparison of intravenous thrombolysis with different bleeding: 3h the timewindow of 115 cases of acute cerebral infarction patients treated with intravenousthrombolysis therapy in 5 patients with intracranial hemorrhage;3-4.5h timewindow group were 81 cases of acute cerebral infarction with intravenousthrombolytic therapy in 12 patientswith intracranial hemorrhage.Comparativeanalysis of 3h and 3-4.5h two time window forintravenous thrombolytic therapy ofintracranial hemorrhage occurred in the case,the difference was statisticallysignificant(P<0.05).5.Thrombolytic therapy group and control group comparison of death:Thrombolytic therapy group were 8 cases died,the mortality was 4.1%; the controlgroup 4 cases died, the mortality was 6.5%, two groups of comparison, thedifference was statistically significant(P<0.05).6. Comparison of death intravenous thrombolytic time window is different:115cases of 3h time window of intravenous thrombolytic therapy in patients with 5cases of death,3-4.5h time window for 81 cases of acute cerebral infarction patientstreated with intravenous thrombolysis therapy in 3 cases of death,two group ofcomparison,no significant difference(P>0.05).ConclusionsThe incidence of patients with acute cerebral infarction within the 4.5h application of rt-PA hassignificant clinical efficacy of intravenous thrombolytic therapy,the overall risk of bleedingin creases somewhat,but did not increase the risk of intracranial hemorrhage, but also reduced the mortality of patients.In the pathogenesis of 3-4.5h given rt-PA vein Rongrong suppository with 3h thrombolysis as can achieve remarkable clinical curative effect,the onsetrisk of contrast 3h thrombolysis in patients with intracranial hemorrhage has increased,but not increased risk of death.