摘要
目的:评价高压氧(HBO)联合低剂量阿替普酶(rtPA)静脉溶栓治疗老年急性缺血性脑卒中(AIS)的疗效及对患者神经认知功能、凝血指标的影响。方法:选入我院2020年1月~2022年12月收治的老年AIS患者60例,随机分为对照组和观察组,各30例。对照组予以HBO+标准剂量(0.9 mg/kg)rtPA静脉溶栓治疗,观察组采用HBO+低剂量(0.6 mg/kg)rtPA治疗。评价两组的治疗效果、神经认知功能及凝血指标等,并进行统计比较。结果:两组治疗总有效率无明显差异(P>0.05);与溶栓前比较,两组溶栓后24 h、7 d时的NIHSS显著下降、MMSE明显升高(P<0.05),但两组之间无明显差异(P>0.05);相较于溶栓前,两组溶栓后7 d时PT、APTT、TT、D-D不同程度增加,Fib明显下降(P<0.05),而观察组增加/下降幅度较小,与对照组差异显著(P<0.05);观察组出血率明显低于对照组(6.67%vs 26.67%,P<0.05);两组死亡率无明显差异(P>0.05)。结论:HBO联合低剂量与标准剂量rtPA静脉溶栓在改善AIS患者神经认知功能、临床疗效及死亡率方面效果相当,但低剂量对血凝功能影响小,同时出血发生风险低。
Objective:To evaluate the efficacy of hyperbaric oxygen(HBO)combined with low dose alteplase(rtPA)intravenous thrombolysis in the treatment of elderly patients with acute ischemic stroke(AIS)and its impact on neurocognitive function and coagulation indicators.Methods:Sixty elderly patients with AIS admitted to our hospital from January 2020 to December 2022 were randomly divided into a control group and an observation group,with 30 patients in each group.The control group was treated with HBO+standard dose(0.9 mg/kg)rtPA intravenous thrombolysis,while the observation group was treated with HBO+low dose(0.6 mg/kg)rtPA.The therapeutic effects,neurocognitive function,and coagulation indicators of the two groups were evaluated and statistically compared.Results:There was no significant difference in the total effective rate between the two groups(P>0.05).Compared with pre thrombolysis,NIHSS significantly decreased and MMSE significantly increased in the two groups at 24 h and 7 d after thrombolysis(P<0.05),but there was no significant difference between the two groups(P>0.05).Compared to before thrombolysis,PT,APTT,TT,and D-D in the two groups increased to varying degrees at 7 days after thrombolysis,while FIB decreased significantly(P<0.05),while the increase/decrease amplitude in the observation group was smaller,with a significant difference compared to the control group(P<0.05).The bleeding rate in the observation group was significantly lower than that in the control group(6.67%vs 26.67%,P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion:HBO combined with low dose and standard dose rtPA intravenous thrombolysis has a similar effect on improving neurocognitive function,clinical efficacy,and mortality in AIS patients,but low dose has a small impact on blood coagulation function and a low risk of bleeding.
作者
吴晓伟
何泉金
康涛生
张荣
李津强
WU Xiao-wei;HE Quan-jin;KANG Tao-sheng;ZHANG Rong;LI Jin-qiang(Department of Neurology,73rd Group Military Hospital of the Chinese People's Liberation Army,Xiamen,Fujian,361000,China)
出处
《现代生物医学进展》
CAS
2023年第19期3646-3650,共5页
Progress in Modern Biomedicine
基金
国家自然科学基金项目(8190021366)。
关键词
急性缺血性脑卒中
高压氧
阿替普酶静脉溶栓
低剂量
疗效
神经认知功能
凝血指标
Acute ischemic stroke
Hyperbaric oxygen
Artiplase intravenous thrombolysis
Low dose
Efficacy
Neurocognitive function
Coagulation indicators