标题：尿激酶对高龄急性脑梗死患者的静脉溶栓效果及其安全性

      作者：高宏章，陈荣平，林鸣    (遂溪县人民医院神经内科，广东 遂溪 524300)

      卷次： 2018年29卷13期

      【摘要】 目的 探讨尿激酶(UK)在高龄急性脑梗死(ACI)患者静脉溶栓中的应用效果和安全性。方法 回顾性分析2016年1月至2017年10月间遂溪县人民医院诊治的60例70岁以上ACI患者(观察组)的临床资料，根据UK剂量不同将其分为低剂量组(20例，100万U)、中等剂量组(20例，120万U)和高剂量组(20例，150万U)，同时选取50例70岁以上急性脑梗死患者为对照组(采用常规抗血小板聚集治疗)，比较各组美国国立卫生院卒中量表(NIHSS)评分，改良RANKIN量表(mRS)评分、Barthel指数(BI)量表评分、疗效及不良反应，随访3个月，观察复发率和死亡率。结果 观察组患者治疗后与治疗前的NIHSS评分[(7.3±1.8)分 vs (13.4±5.7)分]、mRS评分[(0.7±0.2)分 vs (2.5±0.6)分]比较均显著降低，BI指数[(82.3±16.2) vs (42.3±9.2)]显著增高，差异均具有统计学意义(P<0.05)；对照组治疗后的NIHSS评分为(9.4±2.6)分、mRS评分为(1.3±0.5)分、BI指数为(69.3±12.4)，观察组较对照组改善更明显，差异均有统计学意义(P<0.05)；不同剂量组对比，高剂量组、中等剂量组患者的NIHSS评分[(13.1±4.9)分 vs (7.1±1.6)分 vs(8.9±2.4)分]、mRS评分[(0.8±0.4)分 vs (0.8±0.3)分 vs (1.1±0.1)分]、BI指数[(85.3±6.1) vs (89.2±8.3) vs (82.1±7.4)]改善优于低剂量组，差异均有统计学意义(P<0.05)；观察组患者的治疗总有效率为86.7%，血管再通率为35.0%，高于对照组的46.0%和12.0%；死亡率为3.3%，低于对照组的8.0%，差异均具有统计学意义(P<0.05)；不同剂量组间比较，高剂量组出血率为15.0%，明显高于低剂量组的5.0%及中等剂量组的5.0%，差异均有统计学意义(P<0.05)。结论 120万U剂量尿激酶对高龄急性脑梗死患者疗效确切，治疗风险小，安全性高。
      【关键词】 尿激酶；脑梗死；高龄；静脉溶栓；疗效；安全性
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2018）13—1798—04

Effect of urokinase on the efficacy and safety of intravenous thrombolysis in elderly patients with acute cerebralinfarction.
GAO Hong-zhang, CHEN Rong-ping, LIN Ming. Department of Neurology, the People's Hospital of SuixiCounty, Suixi 524300, Guangdong, CHINA
【Abstract】 Objective To explore the effect of urokinase (UK) on the efficacy and safety of intravenous throm-bolysis in elderly patients with acute cerebral infarction (ACI). Methods The clinical data of 60 ACI patients over 70years old (observation group) in the People's Hospital of Suixi County from January 2016 to October 2017 were retro-spectively analyzed. According to the dose of UK, the patients were divided into low dose group (20 cases, 1 millionU), medium dose group (20 cases, 1.2 million U) and high dose group (20 cases, 1.5 million U). A the same time, 50ACI patients over 70 years old were selected as the control group, which were treated with conventional anti-platelet ag-gregation. The NIHSS score, mRS score, BI index, curative effect and adverse reactions were compared. The patientswere followed up for 3 months to observe the recurrence rate and mortality. Results The NIHSS score, mRS score, andBI index in the observation group were (7.3±1.8), (0.7±0.2), (82.3±16.2) after treatment, versus (13.4±5.7), (2.5±0.6),(42.3±9.2) before treatment (P<0.05). The NIHSS score, mRS score, and BI index in the control group was (9.4±2.6),(1.3±0.5), (69.3±12.4) after treatment, and the improvement in the control group was less significant than those in the ob-servation group (P<0.05). Comparison among different dosage groups showed that NIHSS score, mRS score, and BIindex in the high dose group and the medium dose group were significantly better than those in the low dose group(P<0.05): NIHSS (13.1±4.9) vs (7.1±1.6) vs (8.9±2.4), mRS (0.8±0.4) vs (0.8±0.3) vs (1.1±0.1), BI index (85.3±6.1) vs(89.2±8.3) vs (82.1±7.4). The total effective rate of treatment and the rate of vascular recanalization in the observationgroup was 86.7% and 35.0%, significantly higher than 46.0% and 12.0% in the control group (P<0.05). The mortalityrate in the observation group was 3.3%, significantly lower than 8.0% in the control group (P<0.05). The haemorrhagerate of high dose group (15.0%) was significantly higher than that of low dose group (5.0%) and medium dose group(5.0%), and the difference was statistically significant (P<0.05). Conclusion 1.2 million U urokinase is effective andsafe for elderly patients with ACI.
      【Key words】 Urokinase; Cerebral infarction; Elderly; Intravenous thrombolysis; Efficacy; Safety·论 著·doi:10.3969/j.issn.1003-6350.2018.13.007