张媛媛 武晓芳

[摘要] 目的 比較急性期脑梗死患者行阿替普酶（rt-Pa）溶栓和行尿激酶溶栓治疗的效果及安全性。 方法 回顾性收集2019年7月至2020年9月就诊于亳州市人民医院并行静脉溶栓治疗的122例急性脑梗死患者的临床资料，rt-Pa组行rt-Pa溶栓治疗的患者92例，尿激酶组行尿激酶溶栓治疗的患者30例。比较两组患者的一般资料、溶栓后疗效、并发症等。 结果 一般资料：两组的年龄、性别比例、基线美国国立卫生研究院卒中量表（NIHSS）评分、高血压比例、糖尿病比例、基线收缩压、基线血糖、到院至用药时间（DNT）比较，差异无统计学意义（P>0.05）;尿激酶组患者的发病至到院时间长于rt-Pa组，差异有统计学意义（P<0.05）。溶栓后疗效：溶栓后即刻、溶栓后24 h、溶栓后7 d两组的NIHSS评分及死亡率比较，差异无统计学意义（P>0.05）;rt-Pa组有效率为76.09%，尿激酶组有效率为73.33%，组间比较差异无统计学意义（P>0.05）。溶栓后并发症：rt-Pa组出现2例并发颅内出血，尿激酶组无颅内出血病例;rt-Pa组较尿激酶组其他系统出血比例高，差异有统计学意义（P<0.05）。 结论 对于急性期脑梗死，尿激酶溶栓治疗与rt-Pa溶栓治疗同样有效，可改善患者临床症状，且尿激酶溶栓的安全性不低于rt-Pa，尿激酶可于临床推广应用。

[关键词] 急性期脑梗死;阿替普酶;尿激酶;溶栓

[中图分类号] R743.3          [文献标识码] B          [文章编号] 1673-9701（2021）34-0035-04

[Abstract] Objective To compare the efficacy and safety of thrombolytic therapy with alteplase and urokinase in patients with acute cerebral infarction（ACI）. Methods The clinical data of 122 ACI patients treated with intravenous thrombolysis in Bozhou People′s Hospital from July 2019 to September 2020 were collected retrospectively，including 92 patients in rt-Pa group and 30 patients in urokinase group. The general data，curative effect and complications after thrombolysis were compared between the two groups. Results General data：there were no significant differences in age，gender ratio， baseline score of National Institutes of Health Stroke Scale（NIHSS）， proportion of patients with hypertension， proportion of patients with diabetes，baseline systolic blood pressure， baseline blood glucose and Door to Needle Time（DNT） between the two groups（P>0.05）. The time from onset to hospital arrival in urokinase group was longer than that in rt-Pa group， with statistically significant difference（P<0.05）. Efficacy after thrombolysis：There were no significant differences in NIHSS score and mortality between the two groups immediately，24 h and 7 days after thrombolysis（P>0.05）. The effective rates of rt-Pa group and urokinase group were 76.09% and 73.33%， respectively， with no significant differences between the two groups（P>0.05）. Complications after thrombolysis：intracranial hemorrhage occurred in 2 cases in rt-Pa group，but no intracranial hemorrhage occurred in urokinase group. Compared with urokinase group，rt-Pa group had higher bleeding rate in other systems， with statistically significant difference（P<0.05）. Conclusion Retrospective analysis shows that thrombolytic therapy with urokinase is as effective as thrombolytic therapy with rt-Pa for ACI， which can improve patients′ clinical symptoms. The safety of thrombolytic therapy with urokinase is not lower than that with rt-Pa，and urokinase can be widely used in clinic.

[Key words] Acute cerebral infarction; Alteplase; Urokinase; Thrombolysis

急性脑梗死是指各种脑血管病变所致脑部血液供应障碍，导致局部脑组织缺血、缺氧性环死，而迅速出现相应神经功能缺损的一类临床综合征，占我国脑卒中的69.6%～70.8%[1]。卒中具有发病急、进展快、致残率及致死率高的特点，对患者的健康和生命安全造成极大威胁[2-3]。静脉溶栓治疗是急性脑梗死的主要治疗手段之一。临床上常用的静脉溶栓药物包括阿替普酶（Recombinant human tissue plasminogen activatorfor，rt-Pa）和尿激酶，rt-Pa属于第二代溶栓药物，理论上不增加全身纤溶亢进，但价格昂贵，限制了其在基层医院中的临床应用。尿激酶是……