静脉溶栓治疗急性轻型后循环脑梗死的临床研究

Clinical study on intravenous thrombolysis for acute mild posterior circulation infarction

目的探究静脉溶栓治疗急性轻型后循环脑梗死的临床效果。方法50例急性轻型后循环脑梗死患者,根据不同溶栓方法分为对照组(n=28例)和观察组(n=22例)。对照组给予阿司匹林+氯吡格雷溶栓治疗,观察组给予阿替普酶溶栓治疗。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)与拓展版NIHSS(e-NIHSS)评分、凝血功能指标[D-二聚体、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)]及治疗后90 d改良Rankin量表(mRS)评分、复发情况。结果治疗后1、14 d,两组患者的NIHSS、e-NIHSS评分均明显低于治疗前(P<0.05);治疗后14 d,观察组患者的NIHSS评分(0.92±0.25)分、e-NIHSS评分(0.98±0.27)分均明显低于对照组的(1.53±0.31)、(1.57±0.33)分(P<0.05);治疗前及治疗后1 d,两组患者的NIHSS、e-NIHSS评分无统计学差异(P>0.05)。治疗后14 d观察组患者D-二聚体(0.71±0.27)mg/L、APTT(36.23±3.36)s、PT(15.49±1.34)s均明显优于对照组的(1.17±0.35)mg/L、(22.48±3.27)s、(10.31±1.44)s(P<0.05)。观察组患者治疗后90 d mRS评分(1.12±0.54)分明显低于对照组的(1.91±0.63)分(P<0.05);观察组患者复发率0明显低于对照组的17.86%(P<0.05)。结论在急性轻型后循环脑梗死的静脉溶栓治疗中,阿替普酶可从控制病情、提升疗效等方面实现综合效果,且在改善预后、降低复发率方面也有显著的优势,值得推广应用。

Objective To explore the clinical effect of intravenous thrombolysis for acute mild posterior circulation infarction.Methods 50 patients with acute mild posterior circulation infarction were divided into a control group(n=28 cases)and an observation group(n=22 cases)according to different thrombolytic methods.The control group received thrombolytic therapy with aspirin and clopidogrel,while the observation group received thrombolytic therapy with ateplase.Patients in both groups were compared in terms of National Institutes of Health Stroke Scale(NIHSS)score and expanded-NIHSS(e-NIHSS)score,coagulation function indicators[D-dimer,activated partial thromboplastin time(APTT),prothrombin time(PT)]before and after treatment,modified Rankin scale(mRS)score at 90 d after treatment,and recurrence.Results At 1 and 14 d after treatment,NIHSS and e-NIHSS scores in both groups were significantly lower than those before treatment(P<0.05).At 14 d after treatment,the observation group had NIHSS score of(0.92±0.25)points and e-NIHSS score of(0.98±0.27)points,which were significantly lower than(1.53±0.31)and(1.57±0.33)points in the control group(P<0.05).There were no significant differences in NIHSS and e-NIHSS scores between the two groups before treatment and 1 d after treatment(P>0.05).At 14 d after treatment,the observation group had D-dimer of(0.71±0.27)mg/L,APTT of(36.23±3.36)s,PT of(15.49±1.34)s,which were significantly better than(1.17±0.35)mg/L,(22.48±3.27)s,(10.31±1.44)s in the control group(P<0.05).The observation group had mRS score of(1.12±0.54)points at 90 d after treatment,which was significantly lower than(1.91±0.63)points in the control group(P<0.05).The recurrence rate of the observation group was 0,which was significantly lower than 17.86%of the control group(P<0.05).Conclusion In the intravenous thrombolysis treatment of acute mild posterior circulation infarction,alteplase can achieve comprehensive effects in terms of disease control and curative effect,and has significant advantages in improving prognosis and reducing recurrence rate,which is worthy of promotion and application.