亚低温联合阿替普酶对急性脑梗死患者脑血流和神经功能恢复的影响

Effect of mild hypothermia combined withalteplase on cerebral blood flow and recovery of neurological function in patients with acute cerebral infarction

目的探讨亚低温联合阿替普酶治疗急性脑梗死(ACI)患者对脑血流和神经功能恢复的影响。方法回顾性分析2017年3月至2018年3月孝感市中心医院神经外科收治的97例ACI患者的临床资料,根据治疗方法不同分为亚低温组48例、对照组49例,2组患者均采用阿替普酶静脉溶栓治疗,亚低温组同时给予头部局部亚低温治疗。比较2组患者治疗前后的美国国立研究院卒中量表(NIHSS)评分,大脑中动脉(MCA)的收缩期峰值血流速度(Vp)、舒张末期血流速度(Vd)、平均血流速度(Vm),血清超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、神经元特异性烯醇化酶(NSE)、血浆内皮素(ET),以及治疗后不良反应发生率。结果2组入院时NIHSS评分差异无统计学意义(P>0.05);2组患者治疗7 d、14 d、28 d后的NIHSS评分与入院时比较均降低较(P<0.05),亚低温组的NIHSS评分低于对照组(P<0.05)。亚低温组治疗12 h后MCA的Vp、Vd、Vm测定值高于对照组(P<0.05)。亚低温组治疗72 h后血清hs-CRP、IL-1β、MDA、ET低于对照组(P<0.05),亚低温组的血清SOD、GSH-Px高于对照组(P<0.05)。亚低温组和对照组的不良反应发生率比较差异无统计学意义(8.33%vs 16.33%,P>0.05)。结论局部亚低温联合阿替普酶治疗ACI患者有利于尽快缓解患者的氧化应激及炎症反应、改善大脑供血情况,促进神经功能恢复。

Objective To investigate the effects of mild hypothermia combined with alteplase on cerebral hemodynamics and neurological recovery in patients with ACI.Methods The clinical data of 97 patients with ACI admitted to the Department of Neurosurgery from Xiaogan Central Hospital from March 2017 to March 2018 were retrospectively analyzed.According to the treatment,48 patients in the combined group and 49 patients in the control group were included.Both groups were treated with rt-PA intravenous thrombolysis,and the combined group was given partial hypothermia treatment.The NIHSS scores before and after treatment were compared between the two groups.The Vp,Vd,Vm of MCA,serum hs-CRP,IL-1β,SOD,MDA,GSH-Px,NSE,plasma ET and the incidence of adverse reactions.Results At the time of admission,there was no significant difference in NIHSS score between the two groups(P>0.05).After 7d,14 d,and 28 d,NIHSS score of the two groups was lower than those at admission(P<0.05),the NIHSS score of the combined group was lower than that of the control group(P<0.05).After 12 h of treatment,the measured values of Vp,Vd and Vm in the combined group MCA were higher than those in the control group(P<0.05).After treatment for 72 hours,serum hs-CRP,IL-1β,MDA and ET in the combined group were less than those in the control group(P<0.05).Serum SOD and GSH-Px in the combined group were higher than those in the control group(P<0.05).The incidence of adverse reactions in the combined group and the control group were 8.33%and 16.33%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Local hypothermia combined with rt-PA in the treatment of ACI patients is beneficial to relieve oxidative stress and inflammatory response,improve blood supply to the brain,and promote neurological recovery.