数字减影血管造影引导下神经介入取栓联合替罗非班静脉溶栓对急性脑梗死患者的影响

The impact of digital subtraction angiography guided neurointerventional thrombectomy combined with intravenous thrombolysis by tirofiban in acute cerebral infarction patients

目的探讨数字减影血管造影(DSA)引导下神经介入取栓联合替罗非班静脉溶栓对急性脑梗死患者血管再通率、血管内皮功能、血流动力学和神经功能缺损程度的影响。方法选取80例急性脑梗死患者作为研究对象,采用随机数字表法分为观察组和对照组,每组40例。对照组采用DSA引导下神经介入取栓方式治疗,观察组在对照组静脉溶栓基础上加用替罗非班静脉溶栓治疗,比较2组患者的血管再通率、血管内皮功能指标水平、血流动力学指标水平和神经功能缺损程度。结果观察组和对照组的血管再通率分别为90.00%(36/40)和65.00%(26/40),差异有统计学意义(P<0.05);治疗后,2组患者血清内皮素-1(ET-1)水平均较治疗前下降,一氧化氮(NO)水平均较治疗前升高,且观察组ET-1水平低于对照组,NO水平高于对照组,差异有统计学意义(P<0.05);治疗后,2组患者颈动脉外周阻力、特性阻抗均较治疗前下降,平均血流量、平均血流速度均较治疗前提升,且观察组颈动脉外周阻力、特性阻抗低于对照组,平均血流量、平均血流速度高于对照组,差异有统计学意义(P<0.05);治疗后,2组美国国立卫生研究院卒中量表(NIHSS)评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论DSA引导下神经介入取栓联合替罗非班静脉溶栓能够有效提高急性脑梗死患者的血管再通率,改善血管内皮功能,减轻神经功能缺损症状,并增加缺血病灶部位的血流速度和血流量,降低颈动脉外周阻力和特性阻抗。

Objective To investigate the impact of digital subtraction angiography(DSA)-guided neurointerventional thrombus removal combined with intravenous thrombolysis by tirofiban on the rate of recanalization of blood vessels,endothelial function,hemodynamics,and the degree of neurological deficit in patients with acute cerebral infarction.Methods Eighty patients with acute cerebral infarction were selected as study subjects and randomly divided into observation group and control group using the random number table method,with 40 patients in each group.The control group was treated with DSA-guided neurointerventional thrombus removal,and the observation group was treated with intravenous thrombolysis with tirofiban on the basis of the control group.The rates of recanalization of blood vessels,endothelial function index levels,hemodynamic index levels,and the degree of neurological deficit were compared between the two groups.Results The rates of recanalization of blood vessels in the observation group and control group were 90.00%(36/40)and 65.00%(26/40),respectively,with a significant difference(P<0.05).After treatment,the serum endothelin-1(ET-1)levels in both groups were lower than those before treatment,and the nitric oxide(NO)levels were higher than those before treatment,and the ET-1 level in the observation group was lower than that in the control group,and the NO level was higher than that in the control group(P<0.05).After treatment,the carotid extracranial resistance and characteristic impedance in both groups were lower than those before treatment,and the mean blood flow and mean blood flow velocity were higher than those before treatment,and the carotid extracranial resistance and characteristic impedance in the observation group were lower than those in the control group,and the mean blood flow and mean blood flow velocity were higher than those in the control group(P<0.05).After treatment,the National Institutes of Health Stroke Scale(NIHSS)scores in both groups were lower than those before treatment,and the NIHSS score in the observation group was lower than that in the control group(P<0.05).Conclusion DSA-guided neurointerventional thrombus removal combined with intravenous thrombolysis by tirofiban can effectively increase the rate of recanalization of blood vessels in patients with acute cerebral infarction,improve endothelial function,alleviate neurological deficit symptoms,increase blood flow velocity and blood flow at ischemic lesion sites,and reduce carotid extracranial resistance and characteristic impedance.