超早期rt-PA静脉溶栓治疗对青年急性脑卒中患者神经功能和血管再通率的影响

Effect of ultra-early rt-PA intravenous thrombolysis on the neurological function and vascular recanalization rate in young patients with acute stroke

目的分析超早期重组人组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗对青年急性脑卒中患者神经功能和血管再通率的影响。方法前瞻性选取2017年5月至2018年7月青岛市市立医院收治的120例青年急性脑卒中患者的临床资料进行分析,将其随机分为两组。对照组采用常规治疗,观察组采用超早期rt-PA静脉溶栓治疗。比较两组患者治疗前后的血清超氧化物歧化酶(SOD)、丙二醛(MDA)、神经元特异性烯醇化酶(NSE)、S100β蛋白水平;治疗前、治疗后1 d、7 d、14 d患者神经功能缺损(NIHSS)、日常生活活动能力(BI)评分。记录两组患者血管再通情况及不良反应发生情况。结果两组患者治疗前氧化应激因子、神经因子水平组间比较,差异无统计学意义(P>0.05)。观察组患者治疗后SOD水平高于对照组,MDA、NSE、S100β蛋白水平低于对照组(P<0.05)。两组患者治疗前NIHSS、BI评分组间比较,差异无统计学意义(P>0.05)。观察组患者治疗后1 d、7 d、14 d时NIHSS评分低于对照组,BI评分高于对照组(P<0.05)。观察组患者治疗后1个月、2个月、3个月血管再通率分别为58.33%、63.33%、66.67%,对照组为20.00%、28.33%、43.33%,观察组患者血管再通率高于对照组(P<0.05)。两组患者不良反应率比较,差异无统计学意义(P>0.05)。结论超早期rt-PA静脉溶栓治疗青年急性脑卒中,可改善患者神经功能及日常生活活动能力,提高闭塞血管再通率,且不增加不良反应发生率。

Objective To analyze the effect of super-early recombinant human tissue plasminogen activator(rt-PA)intravenous thrombolysis on the neurological function and vascular recanalization rate of young patients with acute stroke.Methods Clinical data of 120 young patients with acute stroke admitted and treated in our hospital from May 2017 to July 2018 were selected for analysis.They were divided into two groups,the control group received conventional treatment,the observation group received ultra-early rt-PA intravenous thrombolysis.Serum superoxide dismutase(SOD),malondialdehyde(MDA),neuron-specific enolase(NSE),and S100βprotein levels were compared between the two groups before and after treatment.Neurological deficits(NIHSS)and activities of daily living(BI)scores before treatment,1 day,7 days,and 14 days after treatment were compared.The revascularization and adverse reactions of the two groups were recorded.Results There was no statistically significant difference between the two groups in the levels of pre-treatment oxidative stress factor and neurofactor(P>0.05).The levels of superoxide dismutase(SOD)in the observation group were higher than those in the control group,and the levels of malondialdehyde(MDA)neuron specific enolase(NSE)S100 protein in the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference between the two groups in the assessment of pretreatment neurological impairment(NIHSS)and daily life activity ability(BI)between the two groups(P>0.05).At 1 d,7 d and 14 d after treatment,the NIHSS score of the observation group was lower than that of the control group,and the BI score was higher than that of the control group(P<0.05).The rate of vascular recanalization in the observation group was 58.33%,63.33%,66.67%,respectively,and that in the control group was 20.00%,28.33%,43.33%,respectively.The rate of vascular recanalization in the observation group was higher than that in the control group(P<0.05).The rate of adverse reactions between the two groups was not statistically significantly different(P>0.05).Conclusion Ultra-early rt-PA intravenous thrombolysis in the treatment of acute stroke in young people can improve the neurological function and daily life activities of patients,improve the rate of occluded vascular recanalization,and do not increase adverse reactions.