急性脑梗死患者溶栓后强化灌注治疗的意义

Significance of Intensive Perfusion Therapy after Thrombolysis in Patients with Acute Cerebral infarction

目的探讨急性脑梗死的患者行静脉溶栓治疗之后序贯应用低分子右旋糖酐进行强化灌注治疗的临床意义。方法回顾性分析盘锦市中心医院神经内科病区从2019年10月至2020年10月收治的86例急性脑梗死患者的临床资料。将86例急性脑梗死患者按照随机法分为两组,对照组和治疗组,每组各43例。对照组患者均在发病后的溶栓时间窗(4.50 h之内)内给予阿替普酶(rt-PA)静脉溶栓治疗。溶栓后再按照急性脑梗死的标准治疗方案进行治疗,治疗组在对照组的治疗基础之上加用低分子右旋糖酐静脉滴注进行强化灌注治疗。应用美国国立卫生院卒中量表(NIHSS)评分分别评估对照组与治疗组患者入院时、溶栓后2 h、溶栓后24 h、溶栓后7 d、溶栓后90 d的临床疗效。结果急性脑梗死患者静脉应用阿替普酶静脉溶栓效果显著,对照组患者及治疗组患者在溶栓后NIHSS评分较溶栓前明显降低。对照组患者与治疗组患者在不同时间节点的NIHSS评分结果比较:两组患者入院时以及溶栓后2 h的NIHSS评分的差异无统计学意义(P>0.05),溶栓后24 h、溶栓后7 d、溶栓后90 d的NIHSS评分差异具有统计学意义(P<0.05)。两组患者合并糖尿病共30例,在低分子右旋糖酐内加入5单位胰岛素注射液以中和葡萄糖,每日定期监测血糖,未发现血糖升高现象,也未出现糖尿病并发症。结论急性脑梗死患者应用阿替普酶静脉溶栓之后序贯应用低分子右旋糖酐进行强化灌注治疗可以明显改善患者预后。

Objective To explore the clinical significance of intensive perfusion therapy after intravenous thrombolytic therapy in patients with acute cerebral infarction.Methods A retrospective analysis of the clinical data of 86 patients with acute cerebral infarction admitted to the neurology ward of Panjin Central Hospital from October 2019 to October 2020.The 86 patients with acute cerebral infarction were randomly divided into two groups,with 43 cases in the control group and the treatment group.Both groups of patients were given intravenous thrombolytic therapy with alteplase(rt-PA)within the thrombolytic time window(within 4.50 hours)after the onset of the disease.After thrombolysis,treatment was carried out in accordance with the standard treatment plan for acute cerebral infarction.On this basis,the treatment group was treated with lowmolecular dextran intravenous drip for intensive perfusion therapy.The National Institutes of Health Stroke Scale(NIHSS)scores were used to evaluate the clinical efficacy of patients in the control group and the treatment group at admission,2 h after thrombolysis,24 h after thrombolysis,7 days after thrombolysis,and 90 days after thrombolysis.Result Intravenous thrombolysis with alteplase in patients with acute cerebral infarction has a significant effect,and the NIHSS scores of patients in the control group and treatment group after thrombolysis were significantly lower than those before thrombolysis.Comparison of NIHSS scores between the control group and the treatment group at different time points:there was no significant difference in the NIHSS scores between the two groups at admission and 2 hours after thrombolysis(P>0.05),the NIHSS scores at 24 h after thrombolysis,7 days after thrombolysis and 90 days after thrombolysis were significantly different(P<0.05).A total of 30 patients in the two groups had diabetes mellitus.5 units of insulin injection were added to low-molecular-weight dextran to neutralize glucose.Blood glucose was monitored regularly every day.No increase in blood glucose was found,and no diabetic complications occurred.Conclusion In patients with acute cerebral infarction,intravenous thrombolysis with alteplase followed by intensive infusion of low-molecular-weight dextran can significantly improve the prognosis of patients.