强化降压用于重症脑梗死的rt-PA静脉溶栓对患者神经功能及出血转化的影响

Effects of intensive anti-hypertensive therapy on nerve function and hemorrhage transformation in patients with severe cerebral infarction undergoing rt-PA intravenous thrombolysis

目的:探讨强化降压用于重症脑梗死的重组组织纤溶酶原激活物(Recombinant tissue plasminogen activator,rt-PA)静脉溶栓对患者神经功能及出血转化的影响。方法:选取2021年1月至2022年1月于本院行rt-PA静脉溶栓治疗的82例重症脑梗死患者,随机分为常规组(n=41)和强化组(n=41),在行常规治疗的同时,常规组予以常规降压治疗,强化组予以强化降压治疗。比较短期内两组患者血压控制、神经功能改善以及溶栓后出血转化情况;比较治疗前后两组炎症控制情况;比较两组治疗期间不良反应发生情况及3 m后患者预后情况。结果:治疗24 h、72 h以及7 d后强化组患者收缩压水平及美国国立卫生研究卒中量表评分均低于常规组(P<0.05);溶栓后72 h内强化组出血转化率及症状性颅内出血率均低于常规组(P<0.05);治疗7 d后两组患者炎症因子水平较治疗前均有降低,且强化组低于常规组(P<0.05);随访3 m后强化组改良Rankin量表评分情况优于常规组(P<0.05);治疗期间两组药物不良反应发生率差异无统计学意义。结论:强化降压处理rt-PA静脉溶栓的重症脑梗死,能有效降低患者炎症水平,缓解其神经功能损伤,减少溶栓后出血转化风险,预后更佳,且不会增加药物不良反应率。

Objective:To explore the effects of intensive anti-hypertensive therapy on nerve function and hemorrhage transformation in patients with severe cerebral infarction undergoing recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis.Methods:A total of 82 patients with severe cerebral infarction undergoing rt-PA intravenous thrombolysis in the hospital were enrolled and randomly divided into routine group(n=41)and intensive group(n=41)between January 2021 and January 2022.On basis of routine treatments,routine group was given routine antihypertensive therapy,while intensive group was given intensive anti-hypertensive therapy.The conditions of blood pressure control,improvement of nerve function and hemorrhage transformation after thrombolysis in a short time,inflammation control before and after treatment,occurrence of adverse reactions during treatment and prognosis at 3 months after treatment were compared between the two groups.Results:At 24 h,72 h and 7 d after treatment,levels of systolic blood pressure and scores of National Institutes of Health Stroke Scale(NIHSS)in intensive group were lower than those in routine group(P<0.05).Within 72 h after thrombolysis,hemorrhage transformation rate and incidence of symptomatic intracranial hemorrhage in intensive group were lower than those in routine group(P<0.05).At 7 d after treatment,levels of inflammatory factors in both groups were decreased,which in intensive group were lower than those in routine group(P<0.05).At 3 months after treatment,score of modified Rankin scale in intensive group was better than that in routine group(P<0.05).The difference in incidence of adverse drug reactions between the two groups was not statistically significant during treatment.Conclusion:The intensive anti-hypertensive therapy for patients with severe cerebral infarction undergoing rt-PA intravenous thrombolysis can effectively reduce inflammation level,relieve neurological damage and reduce the risk of hemorrhage transformation,with better prognosis,without increasing the incidence of adverse drug reactions.