TCD辅助尿激酶静脉溶栓及局部亚低温治疗急性脑梗死的疗效观察

Observation of curative effect of TCD assisted intravenous thrombolysis with urokinase and local mild hypothermia therapy in acute cerebral infarction

目的 探讨TCD辅助尿激酶静脉溶栓及局部亚低温治疗急性脑梗死的疗效。方法 对尿激酶组（24例）给予尿激酶静脉溶栓;亚低温联合组（24例）患者给予尿激酶联合局部亚低温治疗;TCD联合组（25例）患者给予TCD辅助尿激酶静脉溶栓;尿激酶＋TCD＋亚低温组（联合治疗组）（26例）患者给予TCD辅助尿激酶静脉溶栓后再予局部亚低温治疗。于溶栓前、溶栓后2 h、24 h、7 d、14 d采用NIHSS评分评价患者神经功能缺损程度。于3个月后采用mRS评分评价患者的神经功能。结果 TCD联合组及联合治疗组血管再通率显著高于尿激酶组（均P〈0.05）。与溶栓前比较,各组溶栓后各时间点NIHSS评分均显著下降（均P〈0.05）。与尿激酶组比较,TCD联合组及联合治疗组溶栓后各时间点NIHSS评分均显著下降;亚低温联合组溶栓后7 d、14 d时NIHSS评分均显著下降（P〈0.05~0.01）。与亚低温联合组比较,TCD联合组及联合治疗组溶栓后24 h、7 d、14 d时NIHSS评分均显著下降（均P〈0.05）。尿激酶组mRS评分显著高于亚低温联合组、TCD联合组及联合治疗组（均P〈0.05）。联合治疗组mRS评分显著低于亚低温联合组及TCD联合组（均P〈0.05）。各组间并发症发生率差异无统计学意义（均P〉0.05）。结论 TCD辅助溶栓及局部亚低温联合溶栓治疗在改善患者远期功能障碍方面显著优于单用尿激酶溶栓治疗或仅联合TCD及亚低温治疗,且并发症发生率无显著升高,是一种安全、有效的方法。

Objective To investigate the effect of TCD assisted intravenous thrombolysis with urokinase（ UK）and local mild hypothermia therapy in acute cerebral infarction. Methods UK group（ 24 cases） was treated with intravenous thrombolysis with UK; hypothermia combined group（ 24 cases） was treated with UK combination with focal mild hypothermia; TCD combined group（ 25 cases） was treated with UK combination with TCD; TCD ＋ UK ＋mild hypothermia combined group（ combined therapy group,26 cases） was treated with focal mild hypothermia after intravenous thrombolysis with UK assisted by TCD. To evaluate the degree of neural ability defect by NIHSS before and after thrombolysis at 2 h,24 h,7 d,14 d respectively. To evaluate the neurological function by mRS score at 3months after onset. Results The reopen rate of blood vessel of TCD combined group andcombined therapy group were significantly higher than that in UK group（ all P 0. 05）. Compared with before thrombolysis,the NIHSS scores of all the groups at each time point after thrombolysis were significantly decreased（ all P 0. 05）. Compared with UK group,the NIHSS scores of TCD combined group and combined therapy group at each time point after thrombolysis were significantly decreased; the NIHSS scores of hypothermia combined group at 7 d and 14 d after thrombolysis were significantly decreased（ P 0. 05- 0. 01）. Compared with hypothermia combined group,the NIHSS scores of TCD combined group and combined therapy group at 24 h,7 d,14 d after thrombolysis were significantly decreased（ all P 0. 05）. The mRS scores in UK group were significantly higher than those in TCD combined group,hypothermia combined group and combined therapy group（ all P 0. 05）. The mRS scores in combined therapy group were significantly decreased than those in hypothermia combined group and TCD combined group（ all P 0. 05）. There was no statistical significant between incidence of complications in the four groups（ all P 0. 05）. Conclusions In improving long-term dysfunction,TCD assisted intravenous thrombolysis with UK combined with focal cerebral mild hypothermia are significantly superior to the UK only,or with TCD or mild hypothermia seperatly. Furthermore,the incidence of complications has no statistical increase. This therapy is safe and effective.