尿激酶与替罗非班动脉溶栓术联合治疗无明确责任血管的急性脑梗死对患者脑血管功能和预后的影响

Effect of urokinase combined with tirofiban arterial thrombolysis on cerebral vascular function and prognosis of patients with acute cerebral infarction with no definite responsible vessels

目的观察尿激酶与替罗非班动脉溶栓术联合治疗无明确责任血管的急性脑梗死对患者脑血管功能和预后的影响。方法选取该院于2018年1月—2020年5月收治的急性脑梗死患者100例,按照随机数字法分为三组。尿激酶组(n=30)给予尿激酶动脉溶栓治疗,替罗非班组(n=30)给予替罗非班治疗,联合组(n=40)给予尿激酶联合替罗非班动脉溶栓治疗。统计三组有效率和不良反应率,记录三组美国国立卫生院脑卒中(NIHSS)评分、日常生活能力(ADL)评分,检测三组血小板活化因子[血小板膜糖蛋白纤维蛋白原受体(PAC-1)、血小板颗粒膜蛋白-140(GMP-140)、血小板α-颗粒膜糖蛋白(CD62p)]、内皮功能因子[一氧化氮(NO)、内皮素-1(ET-1)]、脑血管储备功能[平均血流速度(MFV)、脑血管反应性(CVR)、屏气指数(BHI)、搏动指数(PI)]、血液流变学指标[全血高切黏度(HWBV)、全血低切黏度(LWBV)、纤维蛋白原(FIB)、D-二聚体(D-D)]的水平。结果联合组疗效高于尿激酶组及替罗非班组,差异有统计学意义(P<0.05)。与治疗前比较,三组的NO上升,PAC-1、CD62p、GMP-140、ET-1下降,且联合组治疗后NO高于尿激酶组及替罗非班组,血小板活化因子、ET-1低于对照组(P<0.05)。与治疗前比较,三组的MFV、CVR、BHI及ADL评分上升,PI、HWBV、LWBV、FIB、D-D及NIHSS评分下降,且联合组治疗后MFV、CVR、BHI及ADL评分高于另外二组,血液流变学指标、PI及NIHSS评分低于尿激酶组及替罗非班组(P<0.05)。三组不良反应比较,差异无统计学意义(P>0.05)。结论尿激酶与替罗非班动脉溶栓术联合治疗无明确责任血管的急性脑梗死可降低血小板活化因子的水平,调节患者血液流动学和内皮功能,增强脑血管储备功能,提高疗效,改善预后。

Objective Observing the effects of combination of urokinase and tirofiban arterial thrombolysis on cerebrovascular function and prognosis in patients with acute cerebral infarction without clear responsible blood vessels.Methods Select one hundred patients with acute cerebral infarction admitted to our hospital from January 2018 to May 2020 and divide them into three groups using random number method.Urokinase group(n=30)received urokinase arterial thrombolysis treatment,tirofiban group(n=30)received tirofiban treatment,and combination group(n=40)received urokinase combined with tirofiban arterial thrombolysis treatment.Calculate the effective rate and adverse reaction rate of three groups,record the National Institutes of Health Stroke(NIHSS)score and Activities of Daily Living(ADL)score of three groups,and detect platelet activating factors in three groups:PAC-1,GMP-140,CD62p,endothelial function factors[nitric oxide(NO),endothelin-1(ET-1)],cerebrovascular reserve function[mean blood flow velocity(MFV),cerebrovascular reactivity(CVR),breath holding index(BHI),pulsatile index(PI)],and hemorheological indicators[whole blood high shear viscosity(HWBV),whole blood low shear viscosity(LWBV),fibrinogen(FIB),D-dimer(D-D)].Results The therapeutic effect of combination group was higher than that of urokinase group and tirofiban(P<0.05).Compared with before treatment,levels of NO in three groups increased,while PAC-1,CD62p,GMP-140,and ET-1 decreased.Combined group had higher levels of NO than urokinase group and tirofiban after treatment,while platelet activating factor and ET-1 were lower than control group(P<0.05).Compared with before treatment,MFV,CVR,BHI,and ADL scores of three groups increased,while PI,HWBV,LWBV,FIB,D-D,and NIHSS scores decreased.In addition,MFV,CVR,BHI,and ADL scores of combination group were higher than those of the other two groups after treatment,while hemorheological indicators,PI,and NIHSS scores were lower than those of urokinase group and tirofiban(P<0.05).There was no statistically significant difference in the comparison of three groups of adverse reactions(P>0.05).Conclusion The combination of urokinase and tirofiban arterial thrombolysis in the treatment of acute cerebral infarction without clear responsible blood vessels can reduce level of platelet activating factor,regulate patient blood flow and endothelial function,enhance cerebrovascular reserve function,improve efficacy,and improve prognosis.