尿激酶超早期静脉溶栓治疗急性脑梗死的效果观察

Therapeutic effects of super early urokinase intravenous thrombolysis on acute cerebral infarction

目的观察尿激酶超早期静脉溶栓治疗急性脑梗死的临床疗效。方法选择2017年9月至2020年3月收治的急性脑梗死患者96例,随机分为对照组和治疗组,每组48例。对照组给予拜阿司匹林+氯吡格雷治疗,治疗组给予尿激酶溶栓治疗。比较2组疗效、出血并发症发生率及治疗前后神经功能、日常生活活动能力、神经因子[脑源性神经营养因子(BDNF)、胰岛素样生长因子-1(IGF-1)、中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)]、炎性因子[肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]变化。结果治疗组总有效率较对照组显著升高,出血并发症发生率较对照组显著降低(P<0.05)。2组治疗前NIHSS评分、MMSE评分、mRS评分、ADL评分、BDNF、IGF-1、NSE、S100β、TNF-α、hs-CRP、SOD、MDA比较差异无统计学意义(P>0.05);2组治疗后NIHSS评分、mRS评分、NSE、S100β、TNF-α、hs-CRP、MDA均较治疗前显著降低,MMSE评分、ADL评分、BDNF、IGF-1、SOD均较治疗前显著升高(P<0.05),且治疗组NIHSS评分、mRS评分、NSE、S100β、TNF-α、hs-CRP、MDA低于对照组,MMSE评分、ADL评分、BDNF、IGF-1、SOD高于对照组(P<0.05)。结论尿激酶超早期静脉溶栓治疗急性脑梗死能够提高治疗效果,改善神经功能和日常生活活动能力,机制与抑制炎性反应和氧化应激有关。

Objective To investigate the therapeutic effects of super early urokinase intravenous thrombolysis on acute cerebral infarction.Methods A total of 96 patients with acute cerebral infarction who were admitted and treated in our hospital from September 2017 to March 2020 were enrolled in the study,who were randomly divided into control group(n=48)and observation group(n=48).The patients in control group were treated by aspirin and clopidogrel,however,the patients in observation group were treated by urokinase intravenous thrombolysis.The curative effects,the incidence rate of bleeding complications and neurological function,activities of daily living,the levels of neurologic factors(BDNF,IGF-1,S100βand NSE),inflammatory cytokines(TNF-αand hs-CRP)and oxidative stress indexes(SOD and MDA)before and after treatment were observed and compared between the two groups.Results The effective rate in observation group was significantly higher than that in control group,and the incidence rate of bleeding complications in observation group was significantly lower than that in control group(P<0.05).Before treatment,there were no significant differences in the NIHSS scores,MMSE scores,mRS scores,ADL scores,BDNF,IGF-1,NSE,S100β,TNF-α,hs-CRP,SOD and MDA between the two groups(P>0.05).After treatment,the NIHSS scores,mRS scores,NSE,S100β,and thelevels of TNF-α,hs-CRP and MDA in both groups were significantly decreased,however,the MMSE scores,ADL scores,BDNF,IGF-1 and SOD in both groups were significantly increased(P<0.05).Moreover the changes in the indexes mentioned above in observation group were more significant than those in control group(P<0.05).Conclusion The urokinase treatment can significantly improve the efficacy in treatment of acute cerebral infarction,and the possible mechanism may be related to reducing the inflammation reaction and oxidative stress,promoting the recovery of nerve function,and improving the activities of daily living of patients.