RÉSUMÉ
Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with maintenance hemodialysis (MHD) and acute ischemic stroke.Methods:The clinical data of 235 patients with acute ischemic stroke receiving MHD were collected in our hospital from March 2018 to October 2021. According to the treatment methods chosen by themselves, these patients were divided into control group ( n=70, only receiving standardized secondary stroke prevention), rt-PA low-dose group ( n=85, receiving rt-PA intravenous thrombolysis, 0.6 mg/kg) and rt-PA standard-dose group ( n=80, receiving rt-PA intravenous thrombolysis, 0.9 mg/kg). The effective rate 24 h after treatment, good efficacy rate 7 d after treatment, and good prognosis rate and mortality 90 d after treatment were used to evaluate the effectiveness. The incidences of intracranial hemorrhage, symptomatic intracranial hemorrhage, and severe extracranial hemorrhage 90 d after treatment were used to evaluate the safety. Results:There was no statistical difference in the good prognosis rate 90 d after treatment among the rt-PA low-dose group, the rt-PA standard-dose group and the control group (71.8%, 68.8%, and 64.3%; P>0.05), but the effective rate 24 h after treatment and good efficacy rate 7 d after treatment in the rt-PA low-dose group and rt-PA standard-dose group (44.7%, 57.7%; 46.3%, 62.5%) were both significantly higher than those in the control group (27.1%, 38.6%; P<0.05). The mortality 90 d after treatment in the rt-PA low-dose group (7.1%) was significantly lower than that in the rt-PA standard-dose group (22.5%) and control group (21.4%, P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in the rt-PA low-dose group (8.2%, 3.5%) were significantly lower than those in the rt-PA standard-dose group (22.5%, 16.3%; P<0.05), and the incidences of extracranial complications and gastrointestinal bleeding (5.9%, 1.2%) were significantly lower than those in the rt-PA standard-dose group (18.8%, 10.0%; P<0.05). Conclusion:Intravenous thrombolytic therapy with 0.6 mg/kg rt-PA is recommended for acute ischemic stroke patients receiving MHD.
RÉSUMÉ
Objective To investigate the prevalence and risk factors of restless leg syndrome (RLS) in hemodialysis patients after kidney transplantation failure.Methods Patients of hemodialysis after kidney transplantation failure were investigated by face-to-face interviews,from March to July,2015,at four dialysis units in Beijing.RLS was diagnosed according to the International RLS Study Group (IRLSSG) criteria.The severity of RLS was assessed using International RLS Rating scale.Besides,three validated sleep disorder questionnaires (Hamilton anxiety and depression scale,Epworth sleepiness scale and Pittsburgh sleep quality index) were completed by the patients at the same time.Results Ninety-four hemodialysis patients after kidney transplantation failure were enrolled;46 patients (48.94％) met the diagnosis of RLS,the average age was 53.44±l 1.89 years,and the median time of RLS onset after kidney transplantation failure was 46 months.The International RLS Rating scale scores of the patients were 17.26±7.81;76.0％ patients were above moderate.As compared with the non-RLS patients,patients with RLS used more erythropoietin (44/48 vs.46/46),less ferrila (30/48 vs.19/46),and few hypnotic medicine (10/48 vs.3/46),with significant differences (P＜0.05).The serum ion,serum ferritin and serum Vitamin B12 of patients with RLS were significantly lower as compared with non-RLS patients (P＜0.05);and poorer sleep quality and higher depression scale scores in the patients with RLS were noted as compared with those in the non-RLS patients (P＜0.05).Conclusion The prevalence of RLS in hemodialysis patients after kidney transplantation failure is high,low iron protein content,low serum iron content and low vitamin B12 levels may be risk factors for RLS.