阿替普酶溶栓桥接Solitaire支架治疗急性缺血性脑卒中的疗效观察

Clinical observation of alteplase thrombolysis bridged solitaire stent in treatment of acute ischemic stroke

目的探讨阿替普酶溶栓桥接Solitaire支架治疗急性缺血性脑卒中(AIS)的疗效及对患者神经功能的影响。方法选取2017年3月~2019年3月广西医科大学附属武鸣医院92例AIS患者根据治疗方法分为溶栓组(46例)和桥接组(46例);溶栓组仅接受阿替普酶静脉溶栓治疗,桥接组在阿替普酶溶栓后桥接Solitaire支架取栓。对比两组患者血管再通情况、美国州立卫生研究院脑卒中表(NIHSS)、改良Rankin表(mRS)、SF-36评分以及临床治疗效果。检测治疗前后患者血清脑源性神经营养因子(BDNF)、神经肽Y(NPY)、中枢神经特异蛋白(S100β)水平。结果桥接组血管再通率为95.65%(44/46),高于溶栓组52.17%(24/46),差异有统计学意义(P<0.05)。与治疗前比较,两组治疗1个月后NIHSS、mRS评分及血清NPY、S100β水平均显著降低,而SF-36评分及血清BDNF水平则明显升高,差异均有统计学意义(P<0.05)。与溶栓组比较,桥接组治疗后NIHSS、mRS评分及血清NPY、S100β水平均降低,SF-36评分及血清BDNF水平均升高,差异均有统计学意义(P<0.05)。桥接组治疗总有效率为73.91%(34/46),显著高于溶栓组45.65%(21/46),差异有统计学意义(P<0.05)。桥接组术后并发症总发生率为15.22%(7/46),显著低于溶栓组28.26%(13/46),差异有统计学意义(P<0.05)。结论阿替普酶溶栓桥接Solitaire支架治疗AIS的效果显著,可有效提高血管再通率,促进患者神经功能恢复和改善术后生活质量。

Objective To investigate the efficacy of alteplase thrombolysis bridged Solitaire stent in treatment of acute ischemic stroke(AIS)and its effect on patients'neurological function.Methods 92 AIS patients were divided into thrombolytic group(46 cases)and bridge group(46 cases)according to the treatment methods.The thrombolytic group was given alteplase thrombolysis only,while the bridge group received alteplase thrombolysis bridged Solitaire stent.Vascular recanalization,NIHSS,modified Rankin scale(mRS),SF-36 score and clinical treatment effect were compared between two groups.The levels of serum brain-derived neurotrophic factor(BDNF),neuropeptide Y(NPY)and S100βwere measured before and after treatment.Results The recanalization rate of bridge group was 95.65%(44/46),which was higher than 52.17%(24/46)of thrombolytic group(P<0.05).NIHSS,mRS score,serum NPY and S100βlevels were significantly reduced in two groups compared with that before treatment,while SF-36 score and serum BDNF levels were significantly increased(P<0.05).Compared with thrombolytic group,the NIHSS,mRS score,serum NPY and S100βlevels in the bridge group were reduced after treatment,while the SF-36 scores and serum BDNF level were increased(P<0.05).The total effective rate of bridge group was 73.91%(34/46),which was significantly higher than 45.65%(21/46)that of thrombolytic group(P<0.05).The total incidence of postoperative complications in bridge group was 15.22%(7/46),which was significantly lower than that 28.26%(13/46)in the thrombolytic group(P>0.05).Conclusion Alteplase bridged Solitaire stent has a significant effect in the treatment of AIS.It can effectively improve the rate of vascular recanalization,promote the recovery of nerve function and improve the postoperative quality of life.