阿替普酶动、静脉溶栓对脑梗死患者神经功能恢复及血流动力学的影响

Effects of arterial and intravenous thrombolysis with arteplase on neurological recovery and hemodynamics in patients with cerebral infarction

目的观察阿替普酶动、静脉溶栓对脑梗死患者神经功能恢复及血流动力学的影响。方法将我院收治的65例脑梗死患者按照治疗方法不同分为动脉溶栓组(33例)和静脉溶栓组(32例)。动脉溶栓组予以阿替普酶动脉溶栓治疗,静脉溶栓组予以阿替普酶静脉溶栓治疗。比较两组的治疗效果、神经功能缺损评分、大脑中动脉血流动力学指标、血清MMP-9、S100-β水平及并发症发生情况。结果动脉溶栓组、静脉溶栓组的治疗总有效率比较,差异不显著(P>0.05)。治疗后14 d,两组NIHSS评分均降低,且动脉溶栓组低于静脉溶栓组(P<0.05)。治疗后2 h,两组Vd、Vp、Vm均升高,且动脉溶栓组高于静脉溶栓组(P<0.05)。治疗后14 d,两组血清MMP-9、S100-β水平均降低,且动脉溶栓组低于静脉溶栓组(P<0.05)。动脉溶栓组并发症总发生率为6.06%,低于静脉溶栓组的28.13%(P<0.05)。结论阿替普酶动、静脉溶栓治疗脑梗死的效果相当,但阿替普酶动脉溶栓可促进患者神经功能恢复,改善大脑中动脉血流动力学,降低血清MMP-9、S100-β水平,安全性高。

Objective To observe the effects of arterial and intravenous thrombolysis with arteplase on neurological recovery and hemodynamics in patients with cerebral infarction. Methods Sixty-five patients with cerebral infarction enrolled in our hospital were divided into arterial thrombolysis group(33 cases) and intravenous thrombolysis group(32 cases) according to the different treatment methods. The arterial thrombolysis group was treated with ateplase arterial thrombolysis, while the intravenous thrombolysis group was treated with ateplase intravenous thrombolysis. The therapeutic effects, neurological deficit scores, middle cerebral artery hemodynamic indexes, levels of serum MMP-9 and S100-β and complications were compared between the two groups. Results There was no significant difference in total effective rates of treatment between the arterial thrombolysis group and intravenous thrombolysis group(P >0.05). At the 14 th day after treatment, the NIHSS scores of the two groups decreased, and that of the arterial thrombolysis group was lower than the intravenous thrombolysis group(P<0.05). At 2 hours after treatment, Vd, Vp and Vm of the two groups increased, and those of the arterial thrombolysis group were higher than the intravenous thrombolysis group(P <0.05). At the 14 th day after treatment, the levels of MMP-9 and S100-β in the two groups decreased, and those of the arterial thrombolysis group were lower than the intravenous thrombolysis group(P<0.05). The total incidence of complications in the arterial thrombolysis group was 6.06%, which was lower than 28.13% in the intravenous thrombolysis group(P<0.05). Conclusion The arterial and intravenous thrombolysis with arteplase in the treatment of cerebral infarction has similar efficacy, but arteplase arterial thrombolysis can promote the recovery of neurological function, improve the hemodynamics of middle cerebral artery, reduce the levels of serum MMP-9 and S100-β, with high safety.