阿替普酶对急性脑梗死患者脑血管储备能力神经功能及生活质量的影响

Effects of alteplase on cerebrovascular reserve capacity,neurologic function and quality of life in patients with acute cerebral infarction

目的探讨阿替普酶静脉溶栓治疗急性脑梗死的临床疗效及对患者脑血管储备能力、神经功能和生活质量的影响.方法将108例急性脑梗死患者按随机数字表法分为两组,每组54例.对照组予以急性脑梗死常规治疗(包括抗血小板聚集、保护神经细胞和改善微循环等治疗);观察组予以阿替普酶静脉溶栓治疗,溶栓24 h后予以急性脑梗死常规治疗.观察2周,随访3个月.比较治疗前后两组临床疗效、脑血管储备功能、神经功能、生活质量及不良反应发生率.结果观察组总有效率为90.7%,对照组为74.1%,观察组显著高于对照组(P<0.05).治疗后两组脑血管储备功能较治疗前显著升高(P<0.05),美国国立卫生研究院卒中量表评分及观察组脉动指数均较治疗前显著降低(P<0.01),两组间比较差异有统计学意义(P<0.05或0.01).随访3个月脑卒中生存质量量表评分较治疗前显著升高(P<0.01),观察组显著高于对照组(P<0.01).两组不良反应发生率比较差异无统计学意义(P>0.05).结论阿替普酶静脉溶栓治疗急性脑梗死能明显提高患者的脑血管储备能力,有利于改善神经功能和生活质量,疗效显著.

Objective To study the effect of alteplase intravenous thrombolysis in the treatment of acute cerebral infarction and its clinical effect on cerebrovascular reserve capacity,neurological function and quality of life.Methods 108 patients with acute cerebral infarction were divided into control group and observation group according to random number table method,54 cases each.The control group received routine treatment of acute cerebral infarction(including anti-platelet aggregation,protection of nerve cells and improvement of microcirculation).The observation group was treated by intravenous thrombolysis with ateplase.After 24 hours of thrombolysis,the routine treatment of acute cerebral infarction was started.Both groups were treated continuously for 2 weeks.The clinical efficacy,cerebrovascular reserve function,neural function,quality of life,and incidence of adverse reactions were compared between the two groups before and after treatment.Results The total effective rate was 90.7%in the observation group and 74.1%in the control group.The observation group was significantly higher than the control group(P<0.05).After treatment,the CVR in the two groups was significantly higher than before treatment(P<0.05),and the PI and NIHSS in the observation group were significantly lower than before treatment(P<0.01).There was a statistically significant difference between the two groups(P<0.05 or 0.01).After 3 months of follow-up,the SS-QOL score was significantly higher than before treatment(P<0.01),and the observation group was significantly higher than the control group(P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Alteplase intravenous thrombolysis can improve cerebrovascular reserve function,improve neurological function and quality of life in patients with acute cerebral infarction.The effect is remarkable and worthy of clinical promotion.