中文摘要：

目的探讨高龄（年龄≥80岁）急性缺血性卒中患者静脉溶栓治疗的安全性和有效性。方法回顾性连续收集2014年7月至2016年2月成都市第三人民医院院神经内科发病4.5 h内应用阿替普酶静脉溶栓的急性脑梗死患者157例,经头部CT或MRI证实。按发病年龄分为≥80岁组（47例）和〈80岁组（110例）。记录基线资料,包括心脑血管病危险因素、美国国立卫生研究院卒中量表评分、发病至溶栓时间（3.0-4.5 h）、应用抗凝药物等;观察患者的不良反应,评估溶栓后安全性和疗效,即7 d和3个月时的病死率、症状性颅内出血率,静脉溶栓24 h、1周内和3个月的恢复良好率。结果 （1）与年龄〈80岁组比较,年龄≥80岁组的心房颤动比例和中位年龄均较高,组间差异有统计学意义[59.6%（28例）比32.7%（36例）,83（81,85）岁比67（59,75）岁,均P〈0.01];其余基线资料的组间差异无统计学意义（均P〉0.05）。（2）脑梗死病因亚组分型中,年龄≥80岁组心源性栓塞比例高于〈80岁组,组间差异有统计学意义[59.6%（28例）比32.7%（36例）,P〈0.01];其余病因分型的组间差异无统计学意义（均P〉0.05）。（3）年龄≥80岁组与年龄〈80岁组患者1周死亡率[分别为6.4%（3例）、6.4%（7例）]及3个月死亡率[12.8%（6例）、9.1%（10例）]的差异均无统计学意义（均P〉0.05）;颅内出血比例[10.6%（5例）、8.2%（9例）]和症状性颅内出血比例[4.3%（2例）、6.4%（7例）]的差异均无统计学意义（均P〉0.05）;24 h恢复良好率[38.3%（18例）、45.5%（50例）]和1周恢复良好率[53.2%（25例）、62.7%（69例）]的差异均无统计学意义（均P〉0.05）;年龄≥80岁组3个月预后良好率低于〈80岁组,组间差异有统计学意义[51.1%（24例）比71.8%（79例）,P〈0.05]。结论对于发病4.5 h内的高龄（年龄≥80岁）急性缺血性卒中患者,选择适当的患者进行静脉溶栓有?

英文摘要：

Objective To investigate the safety and efficacy of intravenous thrombolysis （IVT） in elderly patients （aged≥80 years） with acute ischemic stroke.Methods From July 2014 to February 2016,157 consecutive patients with acute cerebral infarction treated with alteplase for intravenous thrombolysis within 4.5 h after onset at the Department of Neurology,the Third People＇s Hospital of Chengdu were collected retrospectively.They were confirmed by head CT or MRI.They were divided into a ≥80-year old group （n=47） and a 〈80-year old group （n=110） according to the age of onset.The baseline data were documented,including the risk factors for cardiocerebrovascular diseases,National Institute of Health stroke scale （NIHSS） score,onset to thrombolytic time （3.0-4.5 h）,and application of anticoagulant drugs,etc.The adverse reactions of the patients were observed and the safety and efficacy of thrombolysis were evaluated,that is 7 d and 3 months mortality,symptomatic intracranial hemorrhage rate,and good recovery rates of intravenous thrombolysis at 24 h,1 week,and 3 months.Results （1） Compared with the 〈80-year old group,the ratio of atrial fibrillation and median age in the ≥80-year old group were higher.There were significant differences between the two groups （59.6% [n=28] vs.32.7% [n=36],83 [81,85] vs.67 [59,75] years old,all P〈0.01）.There were no significant differences in the remaining baseline data between the two groups （all P〉0.05）.（2） In the subtypes of cerebral infarction etiology,the proportion of cardiogenic embolism in the ≥80-year old group was higher than that in the 〈80-year old group.There was significant difference between the two groups （59.6% [n=28] vs.32.7% [n=36],P〈0.01）.There was no significant difference in the other etiological types between the two groups （all P〉0.05）.（3） There were no significant differences at one week （6.4% [n=3] vs.6.4% [n=7] respectively） and 3 months （12.8% [n=6] vs.9.1% [n=10]） in the mortality ra