阿替普酶联合依达拉奉注射液治疗急性脑梗死的效果分析

Effect analysis of alteplase combined with edaravone injection in the treatment of acute cerebral infarction

目的分析阿替普酶+依达拉奉注射液在急性脑梗死患者中的治疗效果。方法取急性脑梗死患者90例,按治疗方案不同分为参照组、联合组,各45例。参照组采用阿替普酶溶栓治疗,联合组采用阿替普酶溶栓+依达拉奉注射液治疗。比较两组治疗效果,用药安全性,治疗前后的功能评分[美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、生活质量评价量表(SF-36)、Fugl-Meyer运动功能评估量表(FMA)评分]、血液流变学指标[红细胞聚集指数(AI)、全血粘度(WBV)、脑血流量(CBF)、血浆粘度(PV)、血小板聚集率(PAR)]及氧化应激指标[血清一氧化氮(NO)、总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)、活性氧簇(ROS)]。结果较参照组的治疗总有效率82.22%,联合组患者的治疗总有效率95.56%更高,有统计学差异(P<0.05)。参照组患者用药不良反应发生率8.89%与联合组患者的6.67%比较,无明显差异(P>0.05)。较治疗前,两组患者治疗后的NIHSS评分下降,BI、SF-36、FMA评分升高,且治疗后,联合组患者的NIHSS评分(8.89±1.68)分较参照组的(12.37±1.63)分更低,BI评分(73.25±3.13)分、SF-36评分(68.36±3.24)分、FMA评分(63.54±3.27)分较参照组的(62.34±3.12)、(60.13±3.27)、(59.65±3.12)分更高,有统计学差异(P<0.05)。较治疗前,两组患者治疗后的AI、WBV、PV、PAR下降,CBF升高,且治疗后,联合组患者的AI(5.23±0.45)、WBV(5.11±0.72)mPa·s、PV(1.31±0.28)mPa·s、PAR(59.59±4.36)%较参照组的(6.62±0.57)、(6.35±0.81)mPa·s、(2.01±0.41)mPa·s、(66.12±4.23)%更低,CBF(738.45±33.58)ml/min较参照组的(688.45±33.24)ml/min更高,有统计学差异(P<0.05)。较治疗前,两组患者治疗后的NO、SOD、ROS下降,T-AOC升高,且治疗后,联合组患者的NO(5.38±1.22)μmol/L、SOD(124.43±9.12)U/ml、ROS(463.19±30.26)μmol/L较参照组的(7.69±1.13)μmol/L、(156.27±9.46)U/ml、(563.24±30.42)μmol/L更低,T-AOC(18.79±1.85)nmol/L较参照组的(13.47±2.16)nmol/L更高,有统计学差异(P<0.05)。结论阿替普酶+依达拉奉注射液治疗急性脑梗死患者,可提升疗效,改善患者功能状况、血液流变学、氧化应激指标。

Objective To analyze the effect of alteplase+edaravone injection in the treatment of acute cerebral infarction.Methods 90 patients with acute cerebral infarction were selected and divided into a reference group and a combination group according to different treatment plans,with 45 patients in each group.The reference group was given alteplase thrombolytic therapy,and the combination group was given alteplase thrombolytic therapy+edaravone injection.Both groups were compared in terms of treatment effect,medication safety,functional scores[National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI),36-Item Short-Form Health Survey(SF-36),Fugl-Meyer Assessment Scale(FMA)score,indicators of blood rheology[red blood cell aggregation index(AI),whole blood viscosity(WBV),cerebral blood flow(CBF),plasma viscosity(PV),platelet aggregation rate(PAR)]and oxidative stress indicators[serum nitric oxide(NO),total antioxidant capacity(T-AOC),superoxide dismutase(SOD),reactive oxygen species(ROS)]before and after treatment.Results Compared with 82.22%in the reference group,the total effective rate of 95.56%in the combination group was higher,and there was statistical difference(P<0.05).The incidence of adverse drug reactions in the reference group was 8.89%,and the difference was not significant compared with 6.67%in the combination group(P>0.05).Compared with before treatment,NIHSS scores in the two groups decreased after treatment,while BI,SF-36 and FMA scores increased;after treatment,the NIHSS score of(8.89±1.68)points in the combination group was lower than(12.37±1.63)points in the reference group;the combination group had BI score of(73.25±3.13)points,SF-36 score of(68.36±3.24)points and FMA score of(63.54±3.27)points,which were higher than(62.34±3.12),(60.13±3.27)and(59.65±3.12)points in the reference group;there was statistical difference(P<0.05).Compared with before treatment,AI,WBV,PV and PAR decreased and CBF increased in both groups after treatment;after treatment,the combination group had AI of(5.23±0.45),WBV of(5.11±0.72)mPa·s,PV of(1.31±0.28)mPa·s and PAR of(59.59±4.36)%,which were lower than(6.62±0.57),(6.35±0.81)mPa·s,(2.01±0.41)mPa·s and(66.12±4.23)%in the reference group;CBF of(738.45±33.58)ml/min in the combination group was higher than(688.45±33.24)ml/min in the reference group;there was statistical difference(P<0.05).Compared with before treatment,NO,SOD and ROS decreased and T-AOC increased in the two groups after treatment;after treatment,the combination group had NO of(5.38±1.22)μmol/L,SOD of(124.43±9.12)U/ml and ROS of(463.19±30.26)μmol/L,which were lower than(7.69±1.13)μmol/L,(156.27±9.46)U/ml and(563.24±)30.42)μmol/L in the reference group;T-AOC of(18.79±1.85)nmol/L in the combination group was higher than(13.47±2.16)nmol/L in the reference group;there was statistical difference(P<0.05).Conclusion Alteplase+edaravone injection for patients with acute cerebral infarction can enhance the efficacy,improve the functional status,blood rheology and oxidative stress index of patients.