局部亚低温联合rt-PA静脉溶栓治疗对急性大面积脑梗死患者氧化应激及神经功能损伤的影响

Local Mild Hypothermia Combined with rt-PA Intravenous Thrombolysis on Oxidative Stress and Neurological Damage in Patients with Acute Large Area Cerebral Infarction

目的观察局部亚低温联合重组人组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤的影响。方法选取我院2017年6月-2019年12月收治的急性大面积脑梗死患者94例,根据治疗方法的不同分为观察组52例和对照组42例,对照组在对症基础治疗上给予rt-PA静脉溶栓治疗,观察组在对照组治疗基础上联合亚低温治疗。比较两组治疗前1 d及治疗后7 d超氧化物歧化酶(SOD)、丙二醛(MDA)、心型脂肪酸结合蛋白(H-FABP)、N-末端脑钠肽前体(NT-proBNP)、神经元特异烯醇化酶(NSE)、S100B蛋白(S100B)水平,治疗前1 d及治疗后7 d神经功能缺损及日常生活活动能力情况,以及治疗后7 d内不良反应发生情况。结果两组治疗后SOD水平升高、MDA水平降低,且观察组SOD水平升高和MDA水平降低程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。治疗后两组H-FABP、NT-proBNP、NSE及S100B水平均降低,且观察组H-FABP、NT-proBNP、NSE及S100B水平降低程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。与治疗前相比,两组治疗后美国国立卫生研究院卒中量表(NIH stroke scale,NIHSS)评分降低,而Barthel指数(Barthel index,BI)升高,且观察组治疗后NIHSS评分、BI改善程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组治疗后7 d内总不良反应发生率比较差异无统计学意义(χ2=0.158,P=0.691)。结论局部亚低温联合rt-PA静脉溶栓治疗急性大面积脑梗死可显著减轻患者氧化应激反应、脑神经损伤程度,降低相关神经损伤因子水平,改善患者预后。

Objective To observe the effect of local mild hypothermia combined with recombinant human tissue plasminogen activator(rt-PA)intravenous thrombolysis in the treatment of acute large area cerebral infarction and its effect on oxidative stress and neurological damage.Methods A total of 94 patients with acute large area cerebral infarction admitted to our hospital from June 2017 to December 2019 were divided into the observation group(n=52)and the control group(n=42).The control group was treated with rt-PA intravenous thrombolysis on the basis of symptomatic treatment,and the observation group was treated with mild hypothermia on the basis of the control group.The levels of superoxide dismutase(SOD),malondialdehyde(MDA),heart-shaped fatty acid binding protein(H-FABP),N-terminal pro-brain natriuretic peptide(NT proBNP),neuron-specific enolase(NSE)and S100B protein(S100B)neurological deficits and activities of daily living were compared between the two groups before and at 7 days after treatment.The occurrence of adverse reactions within 7 d after treatment was recorded.Results The levels of SOD were increased and MDA was decreased in both groups after treatment,and the increase in SOD and decrease in MDA were greater in the observation group than in the control group(P<0.05 or P<0.01).After treatment,H-FABP,NT proBNP,NSE and S100B were all decreased in the two groups,and the decrease of the above indicators was larger in the observation group than in the control group(P<0.05 or P<0.01).Compared with those before treatment,the NIHSS score of the two groups was decreased,while the Barthel Index(BI)was increased,and the NIHSS score and BI improvement of the observation group after treatment were greater than those of the control group(P<0.05 or P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups within 7 days after treatment(χ2=0.158,P=0.691).Conclusion Local mild hypothermia combined with rt-PA intravenous thrombolysis for acute large area cerebral infarction can significantly reduce the degree of oxidative stress and neurological damage,reduce the level of related nerve injury factors,and improve the prognosis of patients.