替奈普酶与阿替普酶溶栓治疗急性脑梗死的效果及对神经功能恢复与预后的影响

Effects of thrombolysis with tenecteplase or alteplase in the treatment of acute cerebral infarction and the impact on neurological function recovery and prognosis

目的比较急性脑梗死(ACI)患者接受替奈普酶(TNK)与阿替普酶(rt-PA)溶栓治疗效果以及对神经功能恢复、预后的影响。方法回顾性分析2022年7月至2024年5月浙江省舟山市普陀区人民医院收治的80例ACI患者的临床资料,按照不同溶栓治疗药物使用情况分为对照组(使用rt-PA溶栓治疗)与试验组(使用TNK溶栓治疗)各40例,治疗7 d后,观察2组患者生化指标血浆纤维蛋白原(Fbg)、D-二聚体和糖化血红蛋白(HbA 1c)的含量变化;应用美国国立卫生研究院脑卒中量表(NIHSS)评估患者神经受损恢复程度以及治疗总有效率;运用Barthel指数分级法(MBI)评估患者日常活动能力改善情况;观察治疗期间患者不良反应发生情况。结果与治疗前相比,治疗72 h后2组生化指标Fbg、D-二聚体、HbA 1c水平均下降(P<0.05),试验组分别为(2.2±0.6)g/L、(322±35)μg/L、(4.92±0.53)%,对照组为(2.4±0.3)g/L、(317±45)μg/L、(4.87±0.49)%,组间差异无统计学意义(P>0.05);与治疗前相比,治疗24 h、72 h、7 d后2组NIHSS评分均下降(P<0.05),试验组分别为(9.18±2.16)分、(7.52±2.74)分、(3.10±0.85)分,对照组为(10.07±2.23)分、(8.06±2.25)分、(3.37±1.04)分,2组间差异无统计学意义(P>0.05);试验组治疗总有效率为97%,高于对照组(85%),2组差异有统计学意义(P<0.05);治疗24 h、72 h、7 d后2组MBI评分均增加(P<0.05),试验组分别为(42±4)分、(50±6)分、(59±11)分,对照组为(42±4)分、(51±6)分、(60±12)分,2组间差异无统计学意义(P>0.05);试验组不良反应发生率5%,低于对照组(23%)(P<0.05)。结论TNK与rt-PA溶栓能有效改善患者凝血功能、神经功能,提高患者日常活动能力,与rt-PA溶栓相比,TNK溶栓治疗更为方便、安全及有效。

ObjectiveTo compare the effects of thrombolysis with tenecteplase(TNK)and thrombolysis with alteplase(rt-PA)in the treatment of acute cerebral infarction(ACI),and their impacts on neurological function recovery and prognosis.MethodsThe clinical data of 80 patients with ACI admitted to Zhoushan Putuo District People′s Hospital from July 2022 to May 2024 were retrospectively analyzed.According to the use of different thrombolytic drugs,they were divided into a control group(treated with rt-PA thrombolysis)and a experimental group(treated with TNK thrombolysis),with 40 cases in each group.After 7 d of treatment,changes in bio-chemical indicators[plasma fibrinogen(Fbg),D-dimer and glycosylated hemoglobin(HbA 1c)]in both groups were observed.The National Institutes of Health Stroke Scale(NIHSS)and Barthel Index Scale(MBI)were used to evaluate the recovery of neurological damage and daily activity ability of patients in sequence,and the total effective rate and adverse reactions were observed.ResultsAfter 72 h of treatment,there were significant decreases in Fbg,D-Dimer and HbA 1c in both groups(P<0.05),the experimental group were(2.2±0.6)g/L,(322±35)μg/L,and(4.92±0.53)%,respectively,while the control group were(2.4±0.3)g/L,(317±45)μg/L,and(4.87±0.49)%,there was no significant difference between the groups(P>0.05).After 24 h,72 h and 7 d of treatment,NIHSS scores of both groups decreased significantly(P<0.05),the experimental group scored(9.18±2.16),(7.52±2.74),and(3.10±0.85)points respectively,while the control group scored(10.07±2.23),(8.06±2.25),and(3.37±1.04)points respectively,there was no significant difference between the groups(P>0.05).The total effective rate of the experimental group was significantly higher than that of the control group(97%vs 85%,P<0.05).After 24 h,72 h and 7 d of treatment,MBI scores of both groups increased significantly(P<0.05),the experimental group scored(42±4),(50±6),and(59±11)points respectively,while the control group scored(42±4),(51±6),and(60±12)points,there was no significant difference between the groups(P>0.05).The incidence of adverse reactions in the experimental group was significantly lower than that in the control group(5%vs 22%,P<0.05).ConclusionThrombolysis with TNK and rt-PA both can effectively improve coagulation function,neurological function and activities of daily living in patients with ACI.Compared to thrombolysis with rt-PA,thrombolysis with TNK is more convenient,safe and effective.