亚低温联合动脉溶栓治疗急性脑梗死的临床应用价值

Clinical application value of mild therapeutic hypothermia combined with arterial thrombolysis in the treatment of acute cerebral infarction

目的探讨亚低温联合动脉溶栓治疗急性脑梗死的临床应用价值。方法选取2018年1月-2018年12月在本院神经内科住院并行溶栓治疗的急性脑梗死患者60例,并随机分为对照组和观察组,每组30例;对照组患者接受常温下常规动脉溶栓治疗;观察组患者接受亚低温技术联合常规动脉溶栓治疗;记录观察组患者亚低温处理前后收缩压(SBP)、舒张压(DBP)、心率(HR)和呼吸(R)的变化情况;比较2组患者的上消化道出血、肺部感染、静脉血栓形成、脑疝、心律失常等并发症发生情况及病死亡率情况;分析2组患者治疗前后神经功能缺损(NIHSS)评分及改良Rankin量表(mRS)评分。结果 (1)观察组患者在亚低温处理后HR明显降低,与亚低温处理前比较有明显差异(P<0.05);(2)2组患者在上消化道出血、肺部感染、静脉血栓形成、脑疝、心律失常等并发症发生率比较均无明显差异(P>0.05);对照组和观察组发生脑梗死出血性转化分别有2例(6.7%)和10例(33.3%)(P<0.05);观察组和对照组患者发生死亡分别有6例(20.0%)和8例(26.7%)(P>0.05);(3)神经功能缺损评估(NIHSS评分),2组患者溶栓后2、24 h,7和90 d的NIHSS评分与溶栓前比较均有明显差异(P<0.05);观察组2、24 h,7和90 d的NIHSS评分改善较对照组更为明显(P<0.05);(4)观察组治疗14、30和90 d后的mRS评分明显低于对照组(P<0.05)。结论亚低温联合动脉溶栓治疗能明显促进急性脑梗死患者神经功能缺损的恢复,减少脑梗死出血转化的发生。

Objective To explore the clinical application value of mild therapeutic hypothermia combined with arterial thrombolysis in the treatment of acute cerebral infarction. Methods From January 2018 to December 2018, 60 patients with acute cerebral infarction hospitalized in neurology department who underwent thrombolytic treatment were enrolled in our hospital and randomly divided into control group(30 cases) and observation group(30 cases). Patients in the control group received routine thrombolytic therapy at room temperature. The observation group received mild hypothermia combined with routine arterial thrombolysis. The changes of systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and respiration(R) before and after mild hypothermia were recorded in the observation group. The complications of upper gastrointestinal bleeding, pulmonary infection, venous thrombosis, cerebral hernia and arrhythmia in the two groups were statistically compared. The NIHSS score and modified Rankin scale(mRS) score of the two groups before and after treatment were statistically analyzed. Results(1) HR of patients in the observation group was significantly reduced after mild hypothermia treatment, and the difference was statistically significant compared with that before mild hypothermia treatment(P<0.05).(2) There were no statistically significant differences in the incidence of complications such as upper gastrointestinal bleeding, pulmonary infection, venous thrombosis, cerebral hernia and arrhythmia between the two groups(P>0.05). Hemorrhagic transformation of cerebral infarction occurred in 2 cases(6.7%) and 10 cases(33.3%) of the control group and the observation group, respectively(P<0.05). 6(20.0%) and 8(26.7%) patients in the observation group and control group died, respectively(P>0.05).(3) The NIHSS scores of patients in the two groups after 2, 24 h, 7 and 90 d of thrombolysis were statistically significant(P<0.05). NIHSS scores of the observation group after 2, 24 h, 7 and 90 d of thrombolysis were more significantly improved than those of the control group(P<0.05).(4) mRS scores of the observation group after 14, 30 and 90 d of treatment were significantly lower than those of the control group(P<0.05). Conclusion Mild hypothermia combined with arterial thrombolysis could significantly promote the recovery of neurological defects in patients, reduce the occurrence of cerebral infarction and hemorrhage transformation.