Study On Ultra-early Intravenous Rt-PA Thrombolysis Therapy In Patients With Mild Non-disabling Stroke

Objective: By studying the short-term therapeutic effect and safety of thromboembolic plasminogen activator(rt-PA)in patients with mild non-disabling ischemic stroke within 4.5 hours,it is light non-disabled Support for the early intravenous rt-PA thrombolysis in patients with ischemic stroke.Methods: Patients in this study were treated in two tertiary hospitals in Dalian from January 2016 to November 2018.330 non-disabling ischemic stroke patients with onset time less than 4.5 hours and scored less than or equal to 3,according to The National Institutes of Health Stroke Scale(NIHSS),were selected,including 165 patients treated with intravenous rt-PA thrombolysis(thrombolytic group)and 165 patients treated with non-thrombolytic double-antiplatelet therapy(double-antiplatelet group).According to the onset to treatment(OTT)time,age and whether coupled with atrial fibrillation,the thrombolysis group was divided into OTT 3h group and OTT 3-4.5h group,≤80 years old group and > 80 years old group,and the atrial fibrillation group and the non-atrial fibrillation,respectively.The NIHSS and the modified Edinburgh-Scandinavian stroke scale(MESSS)were applied to evaluate the degree of nerve function defect of patients before and after 7 days of treatment,and to compare the short-term therapeutic effect and the situation of the symptomatic intracranial hemorrhage(s ICH)between groups.SPSS 23.0 statistical software was used for data analysis.Results: 1.The differences of age,gender,previous medical history,baseline(blood pressure,blood glucose,NIHSS,MESSS)between the thrombolytic group and the dual antibody group were not statistically significant(P > 0.05).2.There are no statistically significant differences in NIHSS and MESSS scores between the thrombolytic group and the dual antibody group before and after treatment(P > 0.05).After treatment,the differences in NIHSS and MESSS between the two groups were not significant(P>0.05).Compared to the dual antibody group,the thrombolytic group has significantly higher treatment effeciency(40.6%/20.6%,P< 0.05).The rate of deterioration of neurological function(9.1%/7.8%),the incidence of s ICH(1.2%/0),and the mortality rate(0.6%/0)increased,and the difference is not statistically significant(P > 0.05).3.There are no significant difference in NIHSS and MESSS scores before and after treatment between the thrombolytic OTT≤3h group and OTT 3-4.5h group(P > 0.05).Compared to the OTT 3-4.5 group,the OTT≤3h group has higher treatment efficiency(39.4%/42.9%),rate of deterioration of neurological function(6.4%/12.5%)and the incidence of s ICH(0.9%/1.8%),but lower and mortality rate(0.9%/0).The differences are not statistically significant(P > 0.05).4.In the thrombolysis group,≤ 80 years old patients have lower NIHSS and MESSS after treatment(P < 0.05),whereas > 80 years old patients have higher NIHSS and MESSS with no significant difference(P > 0.05).The ≤80 years old group has significantly higher treatment efficiency(43.3%/13.3%)and lower rate of deterioration of neurological function decreased(7.3%/26.7%)than the > 80 years old group The incidence rate of s ICH(0.7%/6.7%)and the mortality rate(0/6.7%)of the ≤ 80 years old group is higher than that of the > 80 years old,with no statistically significant differences(P > 0.05).5.There is no significant difference in NIHSS and MESSS scores between the thrombolytic atrial fibrillation group and the non-atrial fibrillation group before and after treatment(P > 0.05).The treatment efficiency(38.9%/40.8%),the rate of deterioration of neurological function(5.6%/9.5%),the incidence of s ICH(0/1.4%),and the mortality rate(0/0.7%)are lower in the atrial fibrillation group than that in the non-atrial fibrillation group,but the differences were not statistically significant(P > 0.05).Conclusions: 1.Mild non-disabling ischemic stroke patients treated with intravenous rt-PA thrombolytic therapy at an extremely early stage have better short-term prognosis than that treated with dual-antiplatelet therapy.Intravenous rt-PA thrombolytic therapy does not increase the risk of s ICH,but cannot prevent the deterioration of neurological function in some patients.2.Intravenous rt-PA thrombolysis within 4.5 hours after onset of mild non-disabling stroke was significantly better than that of patients aged >80 years.Atrial fibrillation history has no influence on the prognosis.