急性缺血性脑卒中溶栓早期无再通后远期侧支循环开放及神经功能和生活能力康复情况分析

Analysis of long-term collateral circulation opening and rehabilitation of nerve function and living ability after early thrombolysis in acute ischemic stroke without recanalization

目的探讨急性缺血性脑卒中溶栓早期无再通后远期侧支循环开放及神经功能和生活能力的康复情况。方法选取36例实施静脉溶栓无效的急性缺血性脑卒中患者为研究组,另选择36例未接受溶栓治疗的急性缺血性脑卒中患者为对照组。两组患者入院后均实施降调脂、抗血小板凝集以及改善微循环治疗,对照组皮下注射低分子肝素钠治疗,研究组实施尿激酶静脉溶栓治疗。比较两组患者治疗前及治疗后1周、1个月、3个月的神经功能缺损情况、日常生活活动能力、生活质量。结果治疗后1周、1个月、3个月,两组患者的美国国立卫生研究院卒中量表(NIHSS)评分均低于本组治疗前,且研究组治疗后3个月的NIHSS评分(9.53±0.85)分显著低于对照组的(14.32±1.33)分,差异均具有统计学意义(P<0.05);两组患者治疗后1周、1个月组间NIHSS评分比较,差异均无统计学意义(P>0.05)。治疗后1周、1个月、3个月,两组患者的Barthel指数评分、生活质量综合评定问卷(GQOLI-74)评分均高于本组治疗前,且研究组治疗后3个月的Barthel指数评分(88.95±4.54)分、GQOLI-74评分(92.15±5.11)分显著高于对照组的(77.32±4.76)、(85.72±5.66)分,差异均具有统计学意义(P<0.05);两组患者治疗后1周、1个月组间Barthel指数评分、GQOLI-74评分比较,差异均无统计学意义(P>0.05)。结论早期对急性缺血性脑卒中患者实施静脉溶栓治疗相较于未溶栓治疗患者,其远期侧支循环开放情况更优,患者具有更好的神经功能和生活能力恢复情况。

Objective To discuss the long-term collateral circulation opening and rehabilitation of nerve function and living ability after early thrombolysis in acute ischemic stroke without recanalization. Methods There were 36 patients with acute ischemic stroke who were ineffective in intravenous thrombolysis selected as the research group, and 36 patients without thrombolytic therapy as the control group. After admission, both groups were treated with lipid lowering, anti-platelet aggregation and microcirculation improvement. The control group was subcutaneously injected with low molecular weight heparin sodium, and the research group was treated with urokinase intravenous thrombolysis. The neurological deficit, activities of daily living and quality of life before treatment, 1 week, 1 month and 3 months after treatment of the two groups were compared. Results 1 week, 1 month and 3 months after treatment, National Institutes of Health stroke scale(NIHSS) score of the two groups were lower than those before treatment, and NIHSS score 3 months after treatment(9.53±0.85) points was significantly lower than(14.32±1.33) points of the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in NIHSS score 1 week and 1 month after treatment between the two groups(P>0.05). 1 week, 1 month and 3 months after treatment, Barthel index score and generic quality of life inventor-74(GQOLI-74) score of the two groups were higher than those before treatment, and those indexes 3 months after treatment of the research group [(88.95±4.54) and(92.15±5.11) points] were significantly higher than those of the control group [(77.32±4.76) and(85.72±5.66) points], and the difference was statistically significant(P<0.05). 1 week and 1 month after treatment, there was no statistically significant difference in Barthel index score and GQOLI-74 score between the two groups(P>0.05). Conclusion Early intravenous thrombolytic therapy for patients with acute ischemic stroke has better long-term collateral circulation opening than patients without thrombolytic therapy, and patients have better recovery of nerve function and living ability.