不同剂量rt-PA静脉溶栓联合丁苯酞治疗对老年急性脑梗死治疗效果的对比研究

Effect of different doses of rt-PA intravenous thrombolysis combined with butylphthalein in treating elderly acute cerebral infarction

目的:探讨不同剂量阿替普酶(Alteplase,rt-PA)联合丁苯酞治疗老年急性脑梗死(Acute cerebral ischemic,ACI)的临床疗效。方法:收集2021年1月至2023年10月本院90例老年ACI患者的临床资料,根据治疗方案不同分为低剂量组和高剂量组(n=45),分别采用0.6mg·kg^(-1)、0.9 mg·kg^(-1) rt-PA静脉溶栓联合丁苯酞100 mL静脉滴注进行治疗。治疗7 d后比较两组临床疗效、并发症发生情况,采用美国国立卫生院卒中量表(The National Institutes of Health Stroke Scale,NIHSS)评估患者神经功能,采用全自动凝血分析仪检测纤维蛋白原(Fibrinogen,FIB)、凝血酶原时间(Prothrombin time,PT)、活化部分凝血酶时间(Activated partial thromboplastin time,APTT),采用散射免疫比浊法检测[C反应蛋白(C-reactive protein,CRP)、基质金属蛋白酶-9(Matrix metalloprotein-9,MMP-9)、可溶性CD40配体(Soluble CD40 Ligand,sCD40L)]水平。结果:两组临床疗效、并发症发生率比较无显著差异(P>0.05)。治疗3 d后与治疗前相比,两组PT、APTT均显著升高,FIB显著降低,其中高剂量组改善更为显著(P<0.05)。治疗3、7 d后两组患者CRP、MMP-9、sCD40L明显降低(P<0.05),组间无统计学差异(P>0.05)。结论:不同剂量rt-PA联合丁苯酞治疗老年ACI疗效一致,但低剂量能在一定程度上保护凝血功能。

Objective:To investigate the clinical efficacy of different doses of alteplase(rt-PA)combined with butylphthalide in the treatment of acute cerebral ischemic(ACI)in elderly patients.Methods:Clinical data of 90 elderly patients with ACI from January 2021 to October 2023 were collected and divided into a low-dose group and a high-dose group(n=45)according to different treatment regimens.They were treated with intravenous thrombolysis with 0.6 mg·kg-1 and 0.9 mg·kg-1 rt-PA combined with intravenous infusion of 100 mL of butylphthalide.After 7 days of treatment,the clinical efficacy and complications of the two groups were compared.The National Institutes of Health Stroke Scale(NIHSS)was used to assess the neurological function,and the automatic coagulation analyzer was used to detect fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT).Also,the levels of C-reactive protein(CRP),matrix metalloprotein-9(MMP-9),soluble CD40 ligand(sCD40L)were detected using scattering immunoturbidimetry.Results:There was no significant difference in clinical efficacy and complication rate between the two groups(P>0.05).After 3 days of treatment,compared with before treatment,PT and APTT in both groups increased significantly,while FIB decreased significantly,with more significant improvement in the high-dose group(P<0.05).After 3 and 7 days of treatment,CRP,MMP-9,and sCD40L in both groups decreased significantly(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion:The efficacy of different doses of rt-PA combined with butylphthalide in treating elderly ACI is consistent,but low doses can protect coagulation function to a certain extent.