阿替普酶和曲克芦丁脑蛋白水解物联用对溶栓时间窗外急性脑梗死区域组织灌注的影响

Effects of Alteplase Combined with Troxerutin Cerebroprotein Hydrolyzate on Acute Cerebral Infarction Perfusion beyond Thrombolytic Time Window

目的观察阿替普酶联合曲克芦丁脑蛋白水解物治疗溶栓时间窗外急性脑梗死患者的临床疗效。方法60例急性脑梗死患者，按治疗方法分为观察组（阿替普酶联合曲克芦丁脑蛋白水解物）和对照组（曲克芦丁脑蛋白水解物），每组30例。分别在治疗前和治疗后14d行CT灌注成像，对比大脑中动脉（MCA）的峰流速（Vp）、平均流速（Vm）的变化情况及进行NIHSS评分。结果治疗后两组患者梗死中心脑血容量（CBV）、脑血流量（CBF）较治疗前增加，平均通过时间（MTr）较治疗前缩短，且观察组改善程度明显优于对照组（P〈0．05）；治疗后两组患者梗死周围区域CBV均较治疗前增加（P〈0．05），且观察组患者梗死周围区域增加程度明显优于对照组（P〈0．05）；观察组患者梗死周围CBF较治疗前增加（P〈0．05），对照组无明显改善（P〉0．05）；观察组患者梗死周围MTr无明显变化（P〉0．05）。两组患者治疗后梗死中心及梗死周围的相对脑血容量（rCBV）、相对脑血流量（rCBF）较治疗前均有明显增加（P〈0．05），且观察组梗死周围rCBV增加程度明显优于对照组（P〈0．05）。治疗后，两组患者Vp、Vm显著升高，NIHSS评分显著降低，同组治疗前后差异有统计学意义（P〈0．05）；观察组这些指标的改善程度优于对照组（P〈0．05）。结论阿替普酶联合曲克芦丁脑蛋白水解物治疗溶栓时间窗外急性脑梗死，能够改善脑梗死患者梗死中心及其周围区域组织灌注（尤其对梗死周围组织灌注的改善较为明显）、脑血流动力学，急性脑梗死患者神经功能缺损症状，降低NIHSS评分。

Objective To observe efficacy of alteplase combined with troxerutin cerebroprotein hydrolyzate on a- cute cerebral perfusion beyond thrombolytic time window. Methods 60 patients with acute cerebral infarction were selected and divided into observation group（ alteplase combined with troxerutin cerebriprotein hydrolyzate）and control group（ troxerutin cerebroprotein hydrolyzate）with 30 cases in each group. CT perfusion imaging was conducted before treatment and 14 days after treatment. Peak velocity（Vp） of middle cerebral artery （MCA）, changes of mean velocity （Vm） and NIHSS scores were compared. Results Cardio - cerebral blood volume （CBV） and cerebral blood flow （CBF） increased and mean transit time（MTY） decreased after treatment than those before treatment in two groups. The improvements were better in observation group than those in control group（P 〈 0.05 ）. CBV around cerebral infarction after treatment increased than that before treatment in two groups. CBV around cerebral infarction increased more in observation group than that in control group（ P 〈 0.05 ）. CBF around cerebral infarction increased after treatment in observation group（ P 〈 0. 05 ）. There was no significant improvement in control group（ P 〉 0.05 ）. There was no signif- icant improvement on MTT in observation group（ P 〉0. 05 ）. Relative cerebral blood volume（rCBV） and relative cere- bral blood flow（rCBF） in infarction center and around infarction increased after treatment than those before treatment （ P 〈 O. 05 ）. rCBV increased more in observation group than that in control group（ P 〈 0.05 ）. Vp and Vm significant- ly increased, NIHSS scores significantly reduced after treatment than those before treatment（P 〈 0.05）. Improvements of those indicators were better in observation group than those in control group （ P 〈 0.05 ）. Conclusion Alteplase combined with troxerutin cerebroprotein hydrolyzate in the treatment of acute cerebral perfusion beyond thrombolytic time window can improve perfusion in infarction center and surrounding areas, especially for peri - infarction tissue. It can improve cerebral hemodynamics, reduce NIHSS score and improve acute symptoms of neurologic impairment.