吡拉西坦联合阿替普酶静脉溶栓治疗对急性脑梗死患者神经与认知功能、脑血流动力学及炎性因子的影响

Effect of piracetam combined with alteplase intravenous thrombolysis on neurological and cognitive function,cerebral hemodynamic and inflammatory factors in patients with acute cerebral infarction

目的 观察吡拉西坦联合阿替普酶静脉溶栓治疗对急性脑梗死患者神经与认知功能、脑血流动力学及炎性因子的影响。方法 选取2020年4月—2022年4月徐州矿务集团总医院收治的急性脑梗死患者76例,采用随机数字表法分为PIR+rt-PA组和rt-PA组,每组38例。rt-PA组给予阿替普酶静脉溶栓,PIR+rt-PA组在rt-PA组基础上加用吡拉西坦治疗,治疗14 d后比较疗效。比较2组患者治疗前后神经、认知功能改善情况,脑血流动力学指标[平均血流流速(Vm)、平均血流量(Qmean)、舒张末期流速(Vd)、收缩期峰值流速(Vp)、脑血管外周阻力(R)、特征性阻抗(ZCV)]及血清炎性因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]水平。结果 治疗14 d后,2组患者美国国立卫生研究院卒中量表(NIHSS)评分较治疗前降低,简易精神状态检查量表(MMSE)评分较治疗前升高,且PIR+rt-PA组降低/升高幅度大于rt-PA组(P均<0.01);2组患者Vm、Qmean、Vd、Vp较治疗前增加,R、ZCV较治疗前减小,且PIR+rt-PA组增加/减小幅度大于rt-PA组(P均<0.01);2组患者血清TNF-α、IL-6及hs-CRP水平较治疗前降低,且PIR+rt-PA组低于rt-PA组(P均<0.01)。结论 吡拉西坦联合阿替普酶静脉溶栓治疗急性脑梗死,可显著改善患者神经功能和认知功能,调节脑血流动力学,控制炎性因子水平,减轻炎症。

Objective To observe the effect of piracetam combined with alteplase intravenous thrombolysis on neurological and cognitive function,cerebral hemodynamic and inflammatory factors in patients with acute cerebral infarction.Methods A total of 76 patients with acute cerebral infarction admitted to General Hospital of Xuzhou Mining Group from April 2020 to April 2022 were selected and randomly divided into PIR+rt-PA group and rt-PA group using random number table method,with 38 patients in each group.The rt-PA group was given intravenous thrombolytic therapy with alteplase,and the PIR+rt-PA group was given piracetam on the basis of the rt-PA group.The therapeutic effect was compared after 14 days of treatment.The neurological function and cognitive function,cerebral hemodynamic indexes[mean blood flow velocity(Vm),mean blood flow(Qmean),end-diastolic flow velocity(Vd),peak systolic flow velocity(Vp),cerebrovascular peripheral resistance(R),characteristic impedance(ZCV)] and serum inflammatory factors(TNF-α,IL-6,hs-CRP) levels of the two groups before and after treatment were compared.Results After 14 days of treatment,the NIHSS scores of two groups decreased compared to before treatment,while the MMSE scores increased compared to before treatment,and the PIR+rt-PA group showed greater decrease/increase than those of the rt-PA group(P<0.01).The Vm,Qmean,Vd,and Vp of the two groups increased compared to before treatment,while R and ZCV decreased compared to before treatment,the increase/decrease amplitude of the PIR+rt-PA group were greater than those of the rt-PA group(P<0.01).The levels of TNF-α,IL-6 and hs-CRP of two groups decreased compared to before treatment,and the PIR+rt-PA group were lower than the rt-PA group(P<0.01).Conclusion Piracetam combined with alteplase intravenous thrombolysis in the treatment of patients with acute cerebral infarction can improve their neurological function and cognitive function,regulate cerebral hemodynamic,and control the level of inflammatory factors,then reduce inflammatory response.