术前双重抗血小板治疗对Solumbra机械取栓急性脑梗死患者神经功能及血流动力学的影响

Effect of preoperative dual antiplatelet therapy on neurological function and hemodynamics in patients with acute cerebral infarction after mechanical thrombectomy with Solumbra

目的探讨术前双重抗血小板治疗对Solumbra机械取栓急性脑梗死患者神经功能及血流动力学的影响。方法选取2021-01—2022-05首都医科大学附属北京地坛医院收治的急性脑梗死患者84例为研究对象,对照组和观察组患者各42例。对照组患者术前给予阿司匹林抗血小板治疗,观察组患者术前给予双重抗血小板治疗(阿司匹林联合阿加曲班)。2组患者均采用Solumbra机械取栓,对比2组患者NIHSS评分、日常生活质量评分(Barthel指数)、临床治疗效果、血管再通情况、脑血流动力学指标[脑血管外周阻力(R)、平均血流量(Qmean)和平均血流速度(Vmean)]、神经功能指标[神经元特异性稀醇化酶(NSE)、脑特异性蛋白(S100B)、基质细胞衍生因子-1(SDF-1)、视锥蛋白样蛋白-1(VILIP-1)]。结果治疗7 d、治疗30 d后组内比较,观察组NIHSS评分低于对照组、Barthel指数评分高于对照组(P<0.05)。观察组总有效率、血管再通率较对照组高(P<0.05)。治疗后观察组R低于对照组(P<0.05),Qmean和Vmean高于对照组(P<0.05)。治疗后观察组NSE、S100B和VILIP-1低于对照组(P<0.05),SDF-1高于对照组(P<0.05)。结论术前双重抗血小板能够提高急性脑梗死患者的神经功能及日常生活能力,改善血流动力学,具有较高的临床价值。

Objective To investigate the effect of preoperative dual antiplatelet therapy on neurological function and hemodynamics in patients with acute cerebral infarction after mechanical thrombectomy with Solum⁃bra.Methods A total of 84 patients with acute cerebral infarction admitted to our hospital from January 2021 to May 2022 were selected as the research objects and divided into two groups,with 42 cases in both groups.The control group was given aspirin antiplatelet therapy before operation,and the observation group was given dual anti⁃platelet therapy(aspirin combined with agatroban)before operation.Both groups underwent mechanical thrombec⁃tomy using Solumbra.The NIHSS score,quality of daily life score(Barthel index),clinical treatment effect,vascu⁃lar recanalization,cerebral hemodynamic indexes(cerebrovascular peripheral resistance(R),mean blood flow(Qmean)and mean blood flow velocity(Vmean)),neurological function indexes(neuron-specific lethanolase(NSE),and brain specificity protein(S100B),stromal cell-derived factor-1(SDF-1),cone-like protein-1(VILIP-1))were compared between the two groups.Results Comparison within groups after 7 d and 30 d of treatment,the NIHSS score of the observation group was lower than that of the control group and the Barthel index was higher than that of the control group(P<0.05).The total effective rate in the observation group was higher than that in the control group(P<0.05).The revascularization rate in the observation group was higher than that in the control group(P<0.05).After treatment,R in the observation group was lower than that in the control group(P<0.05),and Qmean and Vmean were higher than that in the control group(P<0.05).After treatment,NSE,S100B and VILIP-1 were lower in the observation group than in the control group(P<0.05),and SDF-1 was higher than in the control group(P<0.05).Conclusion Preoperative dual antiplatelet can improve the neurological function and daily living ability of patients with acute cerebral infarction,and improve hemodynamics,which has high clini⁃cal value.