阿替普酶溶栓治疗对老年急性脑梗死患者炎症因子、颅内血流动力学及神经功能的影响

Effects of thrombolysis with ateplase on inflammatory factors,intracranial hemodynamics,and neurological function in elderly patients with acute cerebral infarction

目的探讨阿替普酶溶栓治疗对老年急性脑梗死患者炎症因子、颅内血流动力学及神经功能的影响。方法回顾性分析2017年1月至2019年9月期间空军军医大学第二附属医院急诊科收治的94例老年急性脑梗死患者的临床资料,所有患者均接受抗血小板等常规治疗,疗程为两周。将46例接受阿替普酶溶栓治疗的患者纳入观察组,48例未接受阿替普酶溶栓治疗的患者纳入对照组,比较两组患者治疗前后的血清超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)水平,以及美国国立卫生研究院卒中量表(NIHSS)评分、大脑后动脉收缩期最大血流速度(Vs)、平均血流速度(Vm)和阻力指数(RI)的变化。结果治疗后,观察组患者的NIHSS评分以及血清hs-CRP、TNF-α水平分别为(8.72±1.76)分、(13.16±3.38)mg/L、(28.47±7.12)ng/L,明显低于对照组的(11.43±2.44)分、(20.79±4.25)mg/L、(37.62±8.16)ng/L,差异均有统计学意义(P<0.05);治疗后,观察组患者大脑后动脉Vs、Vm及RI分别为(80.75±14.18)cm/s、(62.17±6.45)cm/s、0.48±0.13,明显优于对照组的(75.09±10.31)cm/s、(55.86±5.27)cm/s、0.63±0.18,差异均有统计学意义(P<0.05);观察组治疗期间的患者总不良反应发生率为7.55%,略高于对照组的3.77%,但差异无统计学意义(P>0.05)。结论阿替普酶溶栓治疗老年急性脑梗死患者可以增加颅内血管血供,抑制炎症反应,进而改善神经功能,提高临床疗效。

Objective To investigate the effect of thrombolysis with ateplase on inflammatory factors,intracranial hemodynamics,and neurological function in elderly patients with acute cerebral infarction.Methods The clinical data of 94 elderly patients with acute cerebral infarction treated in Department of Emergency,Second Affiliated Hospital of Air Force Military Medical University of People's Liberation Army from January 2017 to September 2019 were analyzed retrospectively.All the patients received routine treatment such as antiplatelet,with a course of 2 weeks.Forty-six patients treated by thrombolysis with ateplase were enrolled into the observation group,and 48 patients not treated by thrombolysis with ateplase were enrolled into the control group.The serum levels of high sensitivity C-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α),the NIHSS score,as well as maximum velocity in systolic phase(Vs),the mean flow velocity(Vm),and the resistance index(RI)in the systolic phase of the posterior cerebral artery were compared before and after treatment.Results After treatment,the NIHSS score,serum hs-CRP,and TNF-αlevels in the observation group were(8.72±1.76)points,(13.16±3.38)mg/L,(28.47±7.12)ng/L,significantly lower than(11.43±2.44)points,(20.79±4.25)mg/L,(37.62±8.16)ng/L in the control group(P<0.05).After treatment,the Vs,Vm,and RI of the posterior cerebral artery in the observation group were(80.75±14.18)cm/s,(62.17±6.45)cm/s,and 0.48±0.13,which were significantly better than(75.09±10.31)cm/s,(55.86±5.27)cm/s,and 0.63±0.18 of the control group(P<0.05).The adverse reaction rate in the observation group was 7.55%,which was slightly higher than 3.77%in the control group,with no statistically significant difference(P>0.05).Conclusion Thrombolysis with ateplase can increase the blood supply of intracranial vessels,inhibit the inflammatory reaction,improve the neurological function and improve the clinical effect in the elderly patients with acute cerebral infarction.