阿替普酶静脉溶栓对急性脑梗死患者脑部血液微循环状态及治疗结局的影响

Effects of Intravenous Thrombolysis with Alteplase on Cerebral Blood Microcirculation Status and Treatment Outcomes in Patients with Acute Cerebral Infarction

目的:探究急性脑梗死(ACI)患者应用阿替普酶(rt-PA)静脉溶栓对脑部血液微循环状态及治疗结局的影响。方法:选取2019年2月-2020年2月在费县人民医院接受治疗的ACI患者共124例,采用随机数字表法分为观察组和对照组,各62例。对照组予以尿激酶溶栓,观察组则改用rt-PA静脉溶栓,两组均在溶栓后予以抗血小板聚集、保护脑细胞、改善微循环等治疗。比较治疗后28 d两组不良治疗结局(心房颤动、死亡、症状性颅内出血)的发生率;比较治疗前及治疗后10 d,两组血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度、血细胞比容)变化情况;记录两组治疗前和治疗后3个月的疾病严重程度[美国国立卫生研究院卒中量表(NIHSS)、脑卒中改良Rankin量表(mRS)评分];比较治疗期间两组不良反应(牙龈出血、皮肤黏膜出血、心律失常)发生率。结果:治疗后28 d内,观察组不良治疗结局发生率低于对照组(P<0.05)。治疗后10 d,两组血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度、血细胞比容)水平均较治疗前下降(P<0.05),且观察组均低于对照组(P<0.05)。治疗后3个月,两组NIHSS、mRS评分均较治疗前升高(P<0.05),但观察组低于对照组(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论:rt-PA能够改善ACI患者脑部微循环状态及治疗结局,且治疗安全性良好,值得临床推广。

Objective:To explore the effects of intravenous thrombolysis with Alteplase(rt-PA)on the cerebral blood microcirculation status and treatment outcomes in patients with acute cerebral infarction(ACI).Method:A total of 124 patients with ACI receiving treatment in Fei County People’s Hospital from February 2019 to February 2020 were selected and divided into observation group and control group by the random number table method,with 62 cases in each group.The control group was treated with Urokinase thrombolysis while the observation group was given rt-PA intravenous thrombolysis,and both groups underwent anti-platelet aggregation,cerebral cell protection and microcirculation improvement after thrombolysis.The incidence rates of adverse treatment outcomes(atrial fibrillation,death,symptomatic intracranial hemorrhage)at 28 days after treatment and the changes in hemorheological indicators(high-shear whole blood viscosity,low-shear whole blood viscosity,plasma viscosity,hematocrit)before treatment and at 10 days after treatment were compared between the two groups of patients.The severity of disease[National Institutes of Health stroke scale(NIHSS),stroke modified Rankin scale(mRS)]of the two groups were recorded before treatment and at 3 months after treatment.The incidence rates of adverse reactions(gingival bleeding,mucocutaneous hemorrhage,arrhythmia)between the two groups were compared during treatment.Result:Within 28 days after treatment,the incidence of adverse treatment outcomes in observation group was lower than that in control group(P<0.05).At 10 days after treatment,the levels of hemorheological indicators(high-shear whole blood viscosity,low-shear whole blood viscosity,plasma viscosity and hematocrit)in both groups were lower than those before treatment(P<0.05),and the indicators in observation group were lower than those in control group(P<0.05).At 3 months after treatment,the scores of NIHSS and mRS of the two groups were enhanced compared with those before treatment(P<0.05),but the scores were lower in observation group than those in control group(P<0.05).The incidence rates of adverse reactions in observation group were lower compared with those in control group(P<0.05).Conclusion:rt-PA can improve the cerebral microcirculation status and treatment outcomes of patients with ACI,and it has good treatment safety and is worthy of clinical promotion.