阿加曲班联合rt-PA静脉溶栓治疗急性脑梗死的疗效及对患者脑血管储备功能、大脑中动脉血流动力学指标的影响

Efficacy of argatroban combined with alteplase intravenous thrombolysis in the treatment of acute cerebral infarction and its effects on cerebrovascular reserve function and middle cerebral artery hemodynamic indicators

目的 探究阿加曲班联合阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死的疗效及对患者脑血管储备功能、大脑中动脉血流动力学指标的影响。方法 回顾性分析2019年3月至2022年3月西安高新医院收治的90例急性脑梗死患者的临床资料,根据治疗方法不同分为对照组50例(采用rt-PA静脉溶栓治疗)和观察组40例(采用阿加曲班联合rt-PA静脉溶栓治疗),两组疗程均为7 d。于治疗后比较两组患者的治疗效果,以及治疗前后的脑血管储备功能、大脑中动脉血流动力学指标和治疗期间的不良反应发生情况。结果 观察组患者的治疗总有效率为80.0%,明显高于对照组的60.0%,差异有统计学意义(P<0.05);治疗后,观察组患者的脑血管储备(CVR)、红细胞平均体积(MCV)分别为(41.21±5.45)%、(29.78±3.56) cm/s,明显高于对照组的(30.45±4.48)%、(25.21±3.45) cm/s,搏动指数(PI)为0.68±0.10,明显小于对照组的0.78±0.11,差异均有统计学意义(P<0.05);两组患者治疗后的红细胞聚集指数、全血还原黏度、血小板聚集率均较治疗前降低,且治疗后观察组患者的红细胞聚集指数、全血还原黏度、血小板聚集率分别为1.52±0.25、(9.45±0.61) mPa/s、(40.12±3.11)%,明显低于对照组的2.06±0.16、(10.56±0.89) m Pa/s、(45.36±3.12)%,差异均有统计学意义(P<0.05);治疗后,观察组患者的大脑中动脉平均流速、峰值流速分别为(36.11±4.11) cm/s、(71.21±6.11) cm/s,明显高于对照组的(30.41±3.11) cm/s、(64.11±5.21) cm/s,差异均有统计学意义(P<0.05);观察组和对照组患者的总不良反应发生率分别为16.0%、15.0%,差异无统计学意义(P>0.05)。结论 阿加曲班联合rt-PA静脉溶栓能有效改善急性脑梗死患者脑血管储备功能,同时可改善大脑中动脉血流动力学指标,临床治疗效果显著,具有临床应用价值。

Objective To explore the efficacy of argatroban combined with alteplase(rt-PA)intravenous throm-bolysis in the treatment of acute cerebral infarction and its effects on cerebrovascular reserve function and middle cere-bral artery hemodynamic indicators.Methods The clinical data of 90 patients with acute cerebral infarction admitted to Xi’an Gaoxin Hospital between March 2019 and March 2022 were retrospectively analyzed.According to different treatment methods,the patients were divided into a control group(50 cases,treated with rt-PA intravenous thrombolysis)and an observation group(40 cases,treated with argatroban combined with rt-PA intravenous thrombolysis),for 7 days.After treatment,the therapeutic effect,cerebrovascular reserve function and middle cerebral artery hemodynamic indica-tors before and after treatment,and occurrence of adverse reactions during treatment were compared between the two groups.Results The total effective rate of treatment in the observation group was 80.0%,which was significantly high-er than 60.0%in the control group(P<0.05).After treatment,the cerebrovascular reserve(CVR)and mean corpuscular volume(MCV)in the observation group were(41.21±5.45)%and(29.78±3.56)cm/s,which were significantly higher than(30.45±4.48)%and(25.21±3.45)cm/s in the control group,while the pulsatility index(PI)was 0.68±0.10,signifi-cantly lower than 0.78±0.11 in the control group(P<0.05).After treatment,the red blood cell aggregation index,whole blood reduced viscosity,and platelet aggregation rate in both groups were reduced compared with those before treat-ment,and the above indicators in the observation group were 1.52±0.25,(9.45±0.61)mPa/s,and(40.12±3.11)%,respec-tively,which were significantly lower than 2.06±0.16,(10.56±0.89)mPa/s,and(45.36±3.12)%in the control group(P<0.05).After treatment,the average flow velocity and peak flow velocity of middle cerebral artery in the observation group were(36.11±4.11)cm/s and(71.21±6.11)cm/s,which were significantly higher than(30.41±3.11)cm/s and(64.11±5.21)cm/s in the control group(P<0.05).The total incidence of adverse reactions in the observation group and control group was 16.0%and 15.0%,respectively,with no statistically significant difference(P>0.05).Conclusion Ar-gatroban combined with rt-PA intravenous thrombolysis can effectively improve the cerebrovascular reserve function of patients with acute cerebral infarction and the hemodynamic indexes of middle cerebral artery,with significant clinical treatment effect and high clinical application value.