阿替普酶溶栓治疗对急性脑梗死患者神经功能和颅内血流动力学的影响

Effect of thrombolytic therapy with ateplase on neurological function and intracranial hemodynamics in patients with acute cerebral infarction

目的探讨阿替普酶溶栓治疗对急性脑梗死患者神经功能和颅内血流动力学的影响。方法选择华阴市人民医院神经内科于2017年1月至2018年12月期间收治的53例接受阿替普酶溶栓治疗的急性脑梗死患者作为观察组,同期住院治疗未溶栓的急性脑梗死患者53例作为对照组,观察组患者在常规阿司匹林抗血小板治疗的基础上联合阿替普酶溶栓,对照组患者则仅接受阿司匹林抗血小板等常规治疗。比较两组患者治疗前及治疗后1 h大脑中动脉(MCA)的收缩期最大峰值速度(Vp)、舒张末期流速(Vd)、平均血流速度(Vm);比较两组患者治疗前及治疗后6 h、24 h、7 d及14 d的神经功能缺损程度(NIHSS评分),并比较随访3个月时的生活质量(SS-QOL评分)。结果治疗后1 h,观察组患者MCA的Vp、Vd、Vm分别为(65.38±5.31)cm/s、(51.76±3.67)cm/s、(58.49±3.62)cm/s,明显高于对照组的(61.97±6.05)cm/s、(48.47±3.29)cm/s、(54.25±2.07)cm/s,差异均有统计学意义(P<0.05);治疗后6 h、24 h、7 d及14 d,观察组患者的NIHSS评分明显低于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的不良反应发生率分别为9.43%,3.77%,差异无统计学意义(P>0.05);随访3个月,观察组患者的SS-QOL评分为(168.45±22.79)分,明显高于对照组的(139.12±35.46)分,差异有统计学意义(P<0.05)。结论阿替普酶溶栓应用于急性脑梗死的治疗可以有效改善患者的颅内血流动力学,增加脑血供,减轻神经功能缺损程度,进而有效改善患者的生活质量。

Objective To investigate the effect of thrombolytic therapy with ateplase on neurological function and intracranial hemodynamics in patients with acute cerebral infarction.Methods Fifty-three patients with acute cerebral infarction who received thrombolytic therapy with ateplase in the People’s Hospital of Huayin City from January 2017 to December 2018 were selected as the observation group.Fifty-three patients who did not receive thrombolytic therapy in the same period were included into the control group.Patients in the observation group were treated by thrombolytic therapy with ateplase on the basis of antiplatelet therapy with aspirin,while the patients in the control group were treated with antiplatelet therapy with aspirin.The systolic peak velocity(VP),end diastolic velocity(Vd),and mean velocity of blood flow(Vm)of the middle cerebral artery(MCA)were compared between the two groups before and 1 h after treatment.The degree of neurological deficit(NIHSS score)before and 6 h,24 h,7 d and 14 d after treatment was compared between the two groups,and the quality of life(SS-QOL score)at 3 months of follow-up was compared.Results One hour after treatment,the Vp,Vd,and Vm of MCA in the observation group were(65.38±5.31)cm/s,(51.76±3.67)cm/s,(58.49±3.62)cm/s,respectively,which were significantly higher than(61.97±6.05)cm/s,(48.47±3.29)cm/s,(54.25±2.07)cm/s in the control group(P<0.05).After 6 hours,24 hours,7 days,and 14 days of treatment,the HSNIS scores in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(9.43%vs 3.77%,P>0.05).After three months of follow-up,the SS-QOL score of the observation group was 168.45±22.79,which was significantly higher than 139.12±35.46 of the control group(P<0.05).Conclusion Thrombolytic therapy with ateplase can effectively improve the intracranial hemodynamics,increase the cerebral blood supply,reduce the degree of neurological deficits,and then effectively improve the quality of life of patients with acute cerebral infarction.