rt-PA静脉溶栓联合介入治疗对急性缺血性脑卒中患者MRS评分、Barthel指数、脑部血流动力学的影响

Effects of rt-PA intravenous thrombolysis combined with interventional therapy on MRS score,Barthel index and cerebral hemodynamics in acute isohemic stroke patients

目的探究重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合介入治疗对急性缺血性脑卒中(AIS)患者的影响。方法前瞻性选取2021年1月至2022年6月宜宾市第一人民医院收治的AIS患者106例作为研究对象,按随机数字表法将其分为对照组和观察组,各53例。对照组给予rt-PA进行静脉溶栓治疗,观察组在对照组的基础上进行介入治疗。比较两组的临床疗效;比较两组患者治疗前、治疗后24 h、治疗后3个月的美国国立卫生研究院卒中量表(NIHSS)评分,治疗前、治疗后3个月的改良Rankin’s量表(MRS)评分、Barthel指数、大脑中动脉(MCA)、大脑前动脉(ACA)、基底动脉(BA)的平均血流速度;并记录治疗后3个月内发生的不良反应以及病死率。结果观察组总有效率为88.68%,高于对照组(73.58%),差异有统计学意义(P<0.05)。治疗后24 h、治疗后3个月,两组患者的NIHSS评分均较治疗前均降低,且观察组分别为(6.37±1.24)、(2.67±1.11)分,均低于对照组[(7.25±1.36)、(3.63±1.54)分],差异均有统计学意义(P<0.05)。治疗后3个月,两组MRS评分较治疗前降低,Barthel指数分数较治疗前升高,且观察组MRS评分为(1.98±0.21)分,低于对照组[(2.56±0.34)分],Barthel指数分数为(87.12±6.81)分,高于对照组[(71.33±6.54)分],差异均有统计学意义(P<0.05)。治疗后3个月,两组MCA、ACA、BA的平均血流速度均高于治疗前,且观察组分别为(60.65±5.96)、(43.24±5.36)、(39.86±5.36)cm/s,均高于对照组[(52.33±6.14)、(38.41±5.84)、(34.68±5.72)cm/s],差异有统计学意义(P<0.05)。观察组不良反应率为9.43%,低于对照组(24.53%),差异有统计学意义(P<0.05);两组病死率比较,差异无统计学意义(P>0.05)。结论rt-PA静脉溶栓联合介入治疗有利于AIS患者神经功能恢复,有利于患者生活质量以及日常生活能力的提高,促进脑血流动力学的改善,并能减少不良反应的发生,值得临床推广应用。

Objective To explore the effect of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)combined with interventional therapy on patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 106 AIS patients treated in Yibin First People's Hospital from January 2021 to June 2022.They were divided into the control group and the observation group according to random number table method,with 53 patients in each group.Both groups underwent rt-PA intravenous thrombolysis,and the observation group underwent interventional therapy on this basis.The curative effect was compared between the two groups.The national institutes of health stroke scale(NIHSS)scores before treatment,24 hours after treatment,and 3 months after treatment were compared between the two groups.The modified Rankin's scale(MRS),Barthel index scores,mean blood flow velocity of the middle cerebral artery(MCA),anterior cerebral artery(ACA),and basilar artery(BA)before and 3 months after treatment were compared between the two groups;and the adverse reactions and mortality rate that occurred within 3 months after treatment were recorded.Results The total effective rate of the observation group was 88.68%,higher than that of the control group(73.58%),the difference was statistically significant(P<0.05).After 24 hours and 3 months of treatment,the NIHSS scores of two groups were lower than those before treatment,and those of the observation group were(6.37±1.24)and(2.67±1.11)scores,respectively,which were lower than those of the control group[(7.25±1.36)and(3.63±1.54)scores],the differences were statistically significant(P<0.05).After 3 months of treatment,the MRS scores of the two groups were lower than those before treatment,while the Barthel index scores were higher than those before treatment,MRS score of the observation group was(1.98±0.21)points,which was lower than that of the control group[(2.56±0.34)points],and the Barthel index score was(87.12±6.81)points,which was higher than that of the control group[(71.33±6.54)points],the differences were statistically significant(P<0.05).At 3 months after treatment,the mean flow velocity of MCA,ACA and BA were higher than those before treatment,and those of the mean flow velocity in the observation group were(60.65±5.96),(43.24±5.36),(39.86±5.36)cm/s,respectively,which were higher than those in the control group[(52.33±6.14),(38.41±5.84),(34.68±5.72)cm/s],the differences were statistically significant(P<0.05).The adverse reaction rate in the observation group was 9.43%,which was lower than that in the control group(24.53%),the difference was statistically significant(P<0.05);there was no statistically significant difference in the mortality rate between the two groups(P>0.05).Conclusion Rt-PA intravenous thrombolysis combined with interventional therapy is conducive to the recovery of nerve function,improvement of quality of life,activities of daily living and cerebral hemodynamics in patients with AIS,and reduce the occurrence of adverse reactions.It was worth clinical promotion and application.