血管内机械再通术联合阿替普酶静脉溶栓治疗急性缺血性卒中患者的效果

Effects of endovascular mechanical recanalization combined with intravenous Alteplase thrombolysis in patients with acute ischemic stroke

目的:观察血管内机械再通术联合阿替普酶静脉溶栓治疗急性缺血性卒中(AIS)患者的效果。方法:选取144例AIS患者为研究对象,按随机数字表法分为对照组和观察组,各72例。对照组采用阿替普酶静脉溶栓治疗,观察组在对照组基础上采用血管内机械再通术治疗。比较两组临床疗效、治疗前后大脑中动脉血流动力学指标[搏动指数(PI)、平均流速(Vmean)、阻力指数(RI)和最大流速(Vmax)]水平、神经损伤标志物[中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)]水平、神经功能缺损[美国国立卫生研究院卒中量表(NIHSS)]评分,以及并发症发生率。结果:观察组治疗总有效率为97.22%(70/72),高于对照组的86.11%(62/72),差异有统计学意义(P<0.05);治疗后,观察组PI、RI水平均低于对照组,Vmean和Vmax水平均高于对照组,差异有统计学意义(P<0.05);治疗后,观察组S100β、NSE水平和NIHSS评分均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:血管内机械再通术联合阿替普酶静脉溶栓治疗AIS患者可提高治疗总有效率,改善大脑中动脉血流动力学指标水平,降低神经损伤标志物水平和NIHSS评分,效果优于单纯阿替普酶静脉溶栓治疗。

Objective: To observe effects of endovascular mechanical recanalization combined with intravenous Alteplase thrombolysis in patients with acute ischemic stroke(AIS). Methods: 114 patients with AIS were selected as the research objects and were divided into control group and observation group according to the random number table method, 72 cases in each group. The control group was treated with intravenous Alteplase thrombolysis, while the observation group was treated with endovascular mechanical recanalization on the basis of that of the control group.The clinical effects, the middle cerebral artery hemodynamic index levels [pulsatility index(PI), mean flow velocity(Vmean), resistance index(RI)and maximum flow velocity(Vmax)], the nerve injury marker levels [central nervous system specific protein(S100β), neuron-specific enolase(NSE)],the neurological deficit [national institutes of health stroke scale(NIHSS)] score and the complication rate were compared between the two groups before and after the treatment. Results: The total effective rate of the observation group was 97.22%(70/72), which was higher than the control group of 86.11%(62/72), and the difference was statistically significant(P<0.05). After the treatment, the levels of PI and RI of the observation group were lower than those of the control group;the levels of Vmean and Vmax were higher than those of the control group;and the differences were statistically significant(P<0.05). After the treatment, the levels of S100β, NSE and NIHSS score in the observation group were lower than those in the control group, and the differences were statistically significant(P<0.05). However, there was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusions: Endovascular mechanical recanalization combined with intravenous Alteplase in the treatment of the AIS patients can improve the total effective rate of treatment, improve the hemodynamic index levels of the middle cerebral artery, and reduce the levels of nerve injury markers and the NIHSS score. Moreover, it is superior to single intravenous Alteplase thrombolysis.