超早期脑梗死患者行动静脉不同方式溶栓的效果、凝血功能及神经系统变化分析

Analysis of Intravenous Thrombolytic Effect,Coagulation Function and Nervous System Changes of Different Methods for Cerebral Infarction Patients at Super Early Stage

目的分析超早期脑梗死患者行动静脉不同方式溶栓效果、凝血功能及神经系统变化。方法选取周口人合医院2017年1月—2019年6月收治的脑梗死患者180例,按照梗死系统将其分成静脉组、动脉组。92例颈内静脉系统梗死患者纳入静脉组,将88例椎基底动脉系统梗死患者纳入动脉组。静脉组患者接受经静脉溶栓,动脉组患者接受动脉溶栓。比较两组患者临床疗效、凝血功能、神经细胞因子、神经功能缺损及并发症。结果两组患者临床疗效比较差异无统计学意义(P>0.05)。治疗前两组患者的纤维蛋白原、D-二聚体(D-D)、血小板计数比较差异无统计学意义(P>0.05),治疗后降低;动脉组患者纤维蛋白原、D-D、血小板计数低于静脉组(P<0.05)。治疗前两组患者营养神经因子(NTF)、神经元特异性烯醇化酶(NSE)、神经生长因子(NGF)水平比较差异无统计学意义(P>0.05),术后NTF、NGF增加,NSE降低;其中动脉组患者NTF、NGF高于静脉组(P<0.05),NSE低于静脉组(P<0.05)。治疗前两组患者NIHSS评分比较差异无统计学意义(P>0.05),治疗后降低;其中静脉组患者NIHSS评分低于动脉组(P<0.05)。动脉组患者并发症发生率低于静脉组(P<0.05)。结论早期溶栓静脉溶栓治疗在改善患者凝血功能、神经功能上优于动脉溶栓,但并发症多不及静脉溶栓,建议临床选择针对性治疗方案。

Objective To investigate intravenous thrombolytic effect,coagulation function and nervous system changes of different methods for cerebral infarction patients at super early stage.Methods 180 patients with cerebral infarction in the hospital from January,2017 to June,2019 were enrolled,and they were divided into two groups according to different types of infraction.Intravenous group(n=92)received intravenous thrombolysis and arterial group(n=88)received arterial thrombolysis.Clinical efficacy,coagulation function,nerve cytokines,nerve function deficits and complication rate were compared between the two groups.Results There was no difference in clinical efficacy between groups(P>0.05).There was no difference in fibrinogen,D-D and platelet count between groups before treatment(P>0.05),which were decreased in both groups after treatment(P<0.05),and those were lower in arterial group than in intravenous group(P<0.05).There was no difference in NTF,NSE and NGF levels between groups before treatment(P>0.05).After treatment,NTF and NGF increased,NSE decreased,and both changes were more significant in arterial group than in intravenous group(P<0.05).There was no difference in NIHSS score between groups before treatment(P>0.05),which was decreased in both groups after treatment(P<0.05),and was lower in arterial group than in intravenous group(P<0.05).The incidence rate of complication was lower in arterial group than in intravenous group(P<0.05).Conclusion Early intravenous thrombolysis is better than arterial thrombolysis in improving the coagulation function and nerve function of patients,but its complication rate is high,so treatment for patients should be individualized.