目的：探讨阿替普酶(alteplase，rt-PA)静脉溶栓用于发病3~4.5 h急性脑梗死患者的临床疗效及安全性。方法：将152例发病在3~4.5 h的急性脑梗死患者随机分配至观察组(n=76)和对照组(n=76)，对照组采用拜阿司匹林治疗，观察组在对照组的基础上给予rt-PA静脉溶栓。观察两组临床疗效及治疗期间的出血性转化率。结果：两组治疗前美国国立卫生研究院卒中量表(national institutes of health stroke scale，NIHSS)、Barthel指数(BI)评分比较，差异无统计学意义(P>0.05)，治疗后14，30，90 d观察组的NIHSS评分低于对照组，BI评分高于对照组，差异均有显著统计学意义(P<0.01)；治疗后90 d观察组的改良Rankin量表(mRS)评估结果显著优于对照组(P<0.01)；观察组治疗期间的出血性转化率高于对照组，但两组比较差异无统计学意义(P>0.05)。结论：rt-PA静脉溶栓治疗在3~4.5 h急性脑梗死患者中仍具有显著效果，且并未明显增加出血性转化率。
Clinical efficacy and safety of intravenous thrombolysis treated with alteplase on acute cerebral infarction within 3—4.5 h
Objective: To investigate the clinical efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute cerebral infarction (3—4.5 h). Methods: 152 patients with acute cerebral infarction (3—4.5 h) were randomly assigned to the observation group (n=76) and control group (n=76). The control group was given aspirin therapy, the observation group was given rt-PA intravenous thrombolysis on the basis of the control group. Observed the clinical curative effect of the two groups and the hemorrhagic transformation rate. Results: The difference of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores were not statistically significant (P>0.05) before treatment. The difference of NIHSS and BI scores (14th day, 30th day, 90th day after treatment) of two groups were statistically significant (P<0.01); NIHSS was lower, the BI was higher compared to control group. The modified Rankin scale (mRS) (90th day) in the observation group was significantly better than the control group (P<0.01). The hemorrhagic transformation rate of the observation group was higher than that of the control group, but there was no significant difference between the two groups (P>0.05). Conclusion: rt-PA intravenous thrombolytic therapy in patients with acute cerebral infarction in 3—4.5 h still has significantly effect, and does not significantly increase the rate of hemorrhagic transformation.