急性脑梗死患者应用机械取栓联合尿激酶动脉溶栓治疗的疗效及对神经功能的影响

Therapeutic efficacy of mechanical thrombectomy combined with urokinase arterial thrombolysis on patients with acute cerebral infarction and its impact on neurological function

目的探讨机械取栓联合尿激酶动脉溶栓在急性脑梗死(ACI)患者治疗中的应用效果,并分析其对患者神经功能的影响。方法选取2018年12月至2019年12月昆明医科大学附属延安医院收治的82例ACI患者为研究对象,采用随机数字表法分为观察组(n=41)和对照组(n=41)。对照组患者接受尿激酶动脉溶栓治疗,观察组患者接受尿激酶动脉溶栓联合支架机械取栓治疗。分析比较两组患者血管再通率、神经功能恢复和血清中神经损伤标志物水平。结果治疗后观察组患者血管再通率明显高于对照组,差异有统计学意义(P<0.05);治疗后两组日常生活能力量表(ADL)评分和神经功能缺损量表(NIHSS)评分明显优于治疗前,且观察组改善情况较对照组明显,差异有统计学意义(P<0.05);治疗后两组神经胶质原纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、S100钙结合蛋白B(S100B)、泛素羧基末端水解酶-L1(UCH-L1)水平降低,脑源性神经营养因子(BDNF)、胰岛素样生长因子-I(IGF-I)、神经营养因子(NTF)、血管内皮生长因子(VEGF)水平升高,观察组改善水平明显优于对照组,差异有统计学意义(P<0.05)。结论ACI患者应用尿激酶动脉溶栓联合支架机械取栓治疗,能显著提升血管再通率,改善神经损害程度,值得临床推广应用。

Objective To investigate the application efficacy of mechanical thrombectomy combined with urokinase arterial thrombolysis on patients with acute cerebral infarction,and to analyze its impact on neurological function of patients.Methods A total of 82 patients with acute cerebral infarction admitted to Yan’an Hospital Affiliated to Kunming Medical University from December 2018 to December 2019 were selected as the research object,and they were divided into the observation group(n=41)and the control group(n=41)by random number table method.Patients in the control group were treated with urokinase arterial thrombolysis,while those in the observation group were treated with urokinase arterial thrombolysis combined with stent mechanical thrombectomy.The recanalization rate of blood vessels,the recovery of neurological function and the level of neurological injury markers in serum were analyzed and compared between the two groups of patients.Results After treatment,the recanalization rate of blood vessels in the observation group was significantly higher than that in the control group,with statistically significant difference(P<0.05).After treatment,the ADL score and NIHSS score of the two groups were significantly superior to those before treatment,and the improvement of the observation group was more obvious than that of the control group,with statistically significant difference(P<0.05).After treatment,the levels of GFAP,NSE,S100B and UCH-L1 decreased,while the levels of BDNF,IGF-I,NTF and VEGF increased in the two groups,and the improvement level in the observation group was obviously superior to that in the control group,with statistically significant differences(P<0.05).Conclusion Patients with acute cerebral infarction were treated with urokinase arterial thrombolysis combined with stent mechanical thrombectomy,which significantly increased the recanalization rate of blood vessels and improved the level of neurological injury and was worthy of clinical pro motion and application.