静脉溶栓联合药物治疗轻型缺血性卒中的疗效观察

Therapeutic effect of intravenous thrombolysis combined with drug therapy on mild ischemic stroke

目的探讨静脉溶栓后行双重抗血小板联合小牛血清去蛋白注射液治疗轻型缺血性卒中的疗效。方法选取瑞安市人民医院2017年10月至2018年12月确诊的轻型缺血性卒中患者82例,采用随机数字表法分为对照组(n=41例)和观察组(n=41),对照组静脉溶栓后给予阿司匹林治疗,观察组在对照组基础上联合双重抗血小板和小牛血清去蛋白注射液治疗,两组疗程3个月,比较两组总有效率及治疗前后血液流变学指标变化、神经功能缺损程度改善情况、日常生活能力及回归社会的能力变化,并观察并发症及预后情况。结果观察组总有效率为95.12%(39/41),高于对照组的78.05%(32/41)(χ^2=5.145,P<0.05)。治疗后,观察组美国国立卫生研究院卒中评分量表(NIHSS)评分、改良Rankin评分量表(mRS)评分、Barthel指数(BI)评分分别为(0.34±0.18)分、(92.15±6.73)分、(0.87±0.36)分,对照组分别为(0.92±0.35)分、(76.05±4.86)分、(1.64±0.52)分,两组差异均有统计学意义(t=8.592、11.308、7.099,均P<0.05);观察组全血黏度、血浆黏度、血小板聚集率分别为(4.13±0.36)mPa/s、(1.39±0.31)mPa/s、(32.35±2.61)%,均低于对照组的(8.65±0.72)mPa/s、(1.62±0.47)mPa/s、(39.07±3.25)%(t=32.740、2.382、9.400,均P<0.05)。两组均未出现脑出血和病死病例,两组复发率差异无统计学意义(χ^2=2.565,P>0.05)。结论轻型缺血性卒中患者给予静脉溶栓治疗后,行双重抗血小板联合小牛血清去蛋白注射液治疗能改善患者的神经功能、生活能力及血液流变学指标。

Objective To explore the effect of dual antiplatelet combined with calf serum deproteinized injection in the treatment of mild ischemic stroke after intravenous thrombolysis.Methods From October 2017 to December 2018,82 patients with mild ischemic stroke who were diagnosed in the People's Hospital of Ruian were selected.The patients were divided into control group(41 cases)and observation group(41 cases)according to random number table method.The control group was treated with aspirin after intravenous thrombolysis.On this basis,the observation group was treated with dual antiplatelet combined with calf serum deproteinized injection.The course of treatment was 3 months in both two groups.The total effective rate,the changes of hemorheological indicators,the improvement of neurological deficit,the ability of daily living and the ability of returning to society were compared between the two groups before and after treatment.The complications and prognosis were recorded.Results The total effective rate of the observation group was 95.12%(39/41),which was higher than 78.05%(32/41)of the control group(χ^2=5.145,P<0.05).After treatment,the National Institutes of Health Stroke Score Scale(NIHSS)score,Modified Rankin Score(mRS),Barthel index(BI)score of the observation group were(0.34±0.18)points,(92.15±6.73)points,(0.87±0.36)points,respectively,which of the control group were(0.92±0.35)points,(76.05±4.86)points,(1.64±0.52)points,respectively,there were statistically significant differences between the two groups(t=8.592,11.308,7.099,all P<0.05).The whole blood viscosity,plasma viscosity and platelet aggregation rate of the observation group were(4.13±0.36)mPa/s,(1.39±0.31)mPa/s,(32.35±2.61)%,respectively,which were lower than those of the control group[(8.65±0.72)mPa/s,(1.62±0.47)mPa/s,(39.07±3.25)%](t=32.740,2.382,9.400,all P<0.05).There were no cases of cerebral hemorrhage and death in the two groups,and there was no statistically significant difference in recurrence rate between the two groups(χ^2=2.565,P>0.05).Conclusion After intravenous thrombolytic therapy for patients with mild ischemic stroke,dual antiplatelet therapy combined with calf serum deproteinized injection can improve the neurological function,life ability and hemorheological indicators of patients,with good prognosis,it is safe and effective.