超时间窗醒后缺血性卒中患者与时间窗内患者静脉溶栓治疗的疗效对比

Comparison of the Efficacy of Intravenous Thrombolytic Therapy in Patients with Is-chemic Stroke after Wake-Up beyond the Overtime Window versus Patients within the Time Window

摘要: 目的：探究超静脉溶栓时间窗与静脉溶栓时间窗内醒后缺血性卒中患者使用阿替普酶静脉溶栓治疗的安全性与有效性。方法：选取2019-01~2021-12月烟台毓璜顶医院收治的106例醒后缺血性卒中患者作为研究对象，其中50例患者入睡时间或最后正常时间到静脉溶栓开始时间 < 4.5 h，为时间窗内组(常规组)；56例患者入睡时间或最后正常时间到静脉溶栓开始时间 > 4.5 h，但醒后到静脉溶栓开始时间 < 4.5 h，为超时间窗组(研究组)，根据DWI-FLAIR不匹配筛选出超时间窗患者中可行静脉溶栓治疗的患者，2组患者均进行静脉溶栓治疗。比较2组患者静脉溶栓治疗后颅内出血转化情况、溶栓后效果。结果：2组溶栓后颅内出血转化发生率比较，超静脉溶栓时间窗醒后缺血性卒中患者(n = 56)行静脉溶栓治疗颅内出血转化风险(0% vs 10%; P = 0.021)不高于静脉溶栓时间窗内患者(n = 50)；2组患者短期神经功能预后比较，超静脉溶栓时间窗醒后缺血性卒中患者(n = 56)行静脉溶栓治疗在短期神经功能改善方面(NIHSS评分下降 ≥ 4分) (26.8% vs 52.0%; χ2 = 7.080, P = 0.008)略逊于静脉溶栓时间窗内患者(n = 50)；两组在短期预后良好方面(出院时mRS评分0~2分) (85.7% vs 80.0%; χ2 = 0.612, P = 0.434)无明显差异。结论：超静脉溶栓时间窗醒后缺血性卒中患者行颅脑MRI检查，根据DWI-FLAIR不匹配筛选出可行静脉溶栓治疗患者，静脉溶栓治疗的安全性较高，其有效性略低于在静脉溶栓时间窗内醒后缺血性卒中患者。

Abstract: Objective: To explore the safety and efficacy of alteplase intravenous thrombolysis in patients with ischemic stroke after waking up within the ultra-intravenous thrombolysis time window and the intravenous thrombolysis time window. Methods: 106 patients with wakeful ischemic stroke ad-mitted to Yantai Yuhuangding Hospital in 2019-01~2021-12 as the study object, of which 50 pa-tients fell asleep time or the last normal time to the start time of intravenous thrombolysis < 4.5 h, which was the time window group (conventional group); 56 patients fell asleep time or last normal time to the start time of intravenous thrombolysis > 4.5 h, but after waking up to the onset time of venous thrombolysis < 4.5 h, which was the overtime window group (research group), patients with intravenous thrombolytic therapy were screened for patients with overtime window according to DWI-FLAIR mismatch, and both groups of patients were treated with intravenous thrombolytic therapy. The conversion of intracranial hemorrhage and the effect after thrombolysis were com-pared among the two groups. Results: Comparing the incidence of intracranial hemorrhage conver-sion after thrombolysis in the two groups, patients with ischemic stroke after the ultrasound thrombolytic time window (n = 56) undergo intravenous thrombolytic therapy (0% vs 10%; P = 0.021) was no higher than that of patients within the intravenous thrombolytic time window (n = 50); compared with the short-term neurologic prognosis of patients in 2 groups, patients with is-chemic stroke after the ultrasound intravenous thrombolytic time window (n = 56) underwenous thrombolysis in terms of short-term neurological improvement (NIHSS score decreased ≥ 4 points) (26.8% vs 52.0%; χ2 = 7.080, P = 0.008) was slightly inferior to patients in intravenous thrombolyt-ic time windows (n = 50); both groups had a good short-term prognosis (mRS score of 0 to 2 at dis-charge) (85.7% vs 80.0%; χ2 = 0.612, P = 0.434) and no significant difference. Conclusion: Patients with ischemic stroke after awakening from the ultravenous thrombolytic time window undergo cerebral MRI, and patients with viable intravenous thrombolytic therapy are screened according to the DWI-FLAIR mismatch, and the safety of intravenous thrombolytic therapy is higher, and its ef-fectiveness is slightly lower than that of patients with ischemic stroke after waking up within the intravenous thrombolytic time window.