阿替普酶超早期静脉溶栓治疗急性缺血性脑卒中临床评价

Clinical Evaluation of Ultra-Early Intravenous Thrombolysis with Alteplase in the Treatment of Acute Ischemic Stroke

目的探讨阿替普酶超早期(发病后<6 h)静脉溶栓治疗急性缺血性脑卒中(AIS)的临床疗效。方法选取医院2019年5月至2021年5月收治的AIS患者218例,按随机数字表法分为观察组和对照组,各109例。两组患者均常规给予阿司匹林肠溶片口服及丁苯酞氯化钠注射液静脉滴注,观察组患者加予注射用阿替普酶行超早期静脉溶栓。结果观察组总有效率为32.11%,明显高于对照组的20.18%(P<0.05)。观察组患者治疗后的美国国立卫生研究院卒中量表、改良Rankin量表及神经功能缺损量表评分均明显低于对照组,Barthel指数量表评分明显高于对照组(P<0.05);丙二醛、氧化低密度脂蛋白、可溶性细胞间黏附分子1、血管性血友病因子水平均明显低于对照组,对氧磷酶-1水平明显高于对照组(P<0.05)。观察组与对照组不良反应发生率相当(2.75%比1.83%,P>0.05)。结论阿替普酶超早期静脉溶栓,可进一步提升对AIS的疗效,有助于恢复患者神经功能,减轻机体氧化应激及血管内皮损伤,恢复日常活动能力。

Objective To investigate the clinical efficacy of ultra-early(<6 h after onset)intravenous thrombolysis with ateplase in the treatment of acute ischemic stroke(AIS).Methods A total of 218 patients with AIS admitted to the hospital from May 2019 to May 2021 were selected and divided into the observation group and the control group according to the random number table method,with 109 cases in each group.The patients in the two groups were routinely given the oral administration of Aspirin Enteric-Coated Tablets and intravenous drip of Butylphthalide Sodium Chloride Injection,on this basis,the patients in the observation group were given ultra-early intravenous thrombolysis with Alteplase for Injection.Results The total effective rate in the observation group was 32.11%,which was significantly higher than 20.18%in the control group(P<0.05).After treatment,the scores of the National Institutes of Health Stroke Scale(NIHSS),modified Ranking Scale(mRS)and Neurological Functional Defect Scale(NFDS)in the observation group were significantly lower than those in the control group,while the score of Barthel Index(BI)in the observation group was significantly higher than that in the control group(P<0.05).The levels of malondialdehyde(MDA),oxidized low-density lipoprotein(ox-LDL),soluble intercellular adhesion molecule-1(sICAM-1)and von-Willebrand factor(vWF)in the observation group were significantly lower than those in the control group,while the level of paraoxonase-1(PON-1)in the observation group was significantly higher than that in the control group(P<0.05).The incidence of adverse drug reactions in the observation group was similar to that in the control group(2.75%vs.1.83%,P>0.05).Conclusion Ultra-early intravenous thrombolysis with alteplase in the treatment of AIS can further improve the therapeutic effect,help to restore the patients'neurological function,reduce the patients'oxidative stress and vascular endothelial injury,and restore the patients'ability of daily activities.