Effects of butyphthalide + rt-PA intravenous thrombolysis on the DWI characteristics, coagulation function and neurological function in patients with acute cerebral infarction

Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.

Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

BACKGROUND： Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE： To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN： Observation experiment. SETTING： Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS： Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46- 79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease （1995） and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS： On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4 - 8 IU/kg per hour was intravenously administrated for anticoagulation for 7 - 10 days successively. MAIN OUTCOME MEASURES： Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients （1995）. Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS： Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time： Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis （t =3.45, P 〈 0.01）. Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found （P 〉 0.05）. Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis （t =4.769, P 〈 0.01）. ②Therapeutic effect and modified Rankin scale results： 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients （80%）, 3 to 4 in 2 patients （13.3%） and 6 in 1 patient （6.7%）. Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION： Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.

Clinical study about mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction

Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group (n=100 cases, receiving routine intravenous thrombolysis therapy) and the mild hypothermia group (n=76, receiving mild hypothermia + intravenous thrombolysis therapy), and the treatment lasted for 1 week. The differences in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment. Results: Before treatment, there was no statistically significant difference in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters between the two groups. After 1 week of treatment, serum nerve injury indexes H-FABP, NT-proBNP, NSE and S100B levels of mild hypothermia group were lower than those of routine group;inflammatory mediators sICAM-1, IL-8, IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group. Conclusion: mild hypothermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response, and optimize the neurotransmitter distribution in patients with acute cerebral infarction.

Effects of Intravenous Thrombolytic Therapy with Alteplase on Neurological Function,Coagulation Function and Serum Inflammatory Factors in Patients with Acute Cerebral Infarction

Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.

Evaluation of vascular recanalization rate and nerve injury of mechanical thrombectomy combined with rt-PA thrombolysis in treatment of acute cerebral infarction

Objective:To investigate the vascular recanalization rate of mechanical thrombectomy combined with recombinant tissue-type plasminogen activator (rt-PA) thrombolysis in the treatment of acute cerebral infarction and the effect on the nerve injury in patients.Methods:A total of 90 patients with acute cerebral infarction who were treated in our hospital between January 2016 and January 2019 were retrospectively analyzed and divided into the control group (n=46) receiving rt-PA thrombolysis and the observation group (n=44) receiving mechanical thrombectomy combined with rt-PA thrombolysis. The differences in vascular recanalization rate 24 h after treatment as well as serum levels of inflammatory mediators [interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-17 (IL-17) and hypersensitive C-reactive protein (hs-CRP)], nerve injury markers [brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE) and S100B protein (S100B)] and neurotransmitters [glutamate (Glu) and 5-hydroxytryptamine (5-HT)] before and after treatment were compared between the two groups of patients.Results: 24 h after treatment, the vascular recanalization rate of the observation group was higher than that of the control group (P<0.05). 24 h after treatment and 1 week after treatment, serum IL-1, IL-6, IL-7, IL-17 and hs-CRP levels in the observation group were lower than those in the control group;BDNF level was higher than that in the control group, while NSE and S100B levels were lower than those in the control group;Glu and 5-HT levels were lower than those in the control group (P<0.05). Conclusions: Mechanical thrombectomy combined with rt-PA thrombolysis can increase the early postoperative vascular recanalization rate in patients with acute cerebral infarction, and it also plays an active role in alleviating nerve injury.

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale(NIHSS) scores were statistically decreased in both groups(P>0.05) at 24 hours and 7 days after ACI.There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups(P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rtPA within 4.5 hours after the onset of this disease.Therefore,intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.

Clinical treatment strategy of acute cerebral infarction complicated with pulmonary embolism: a case report

This article describes the clinical characteristics of a case of cerebral infarction complicated with pulmonary embolism(PE),and elaborates the therapeutic strategies of intravenous thrombolysis and anticoagulation.Treatment remedies:the medical history and examination data of a patient with aphasia and right hemiplegia were collected.After intravenous thrombolysis and pulmonary artery CTA(computed tomographic angiography),the patient was found to have low blood oxygen saturation and PE.And the patient was treated with anticoagulant therapy.Post treatment evaluating:cerebral hemorrhage was excluded by craniocerebral CT(computed tomographic),and left basal ganglia infarction was diagnosed.After thrombolysis,the symptoms of aphasia and hemiplegia were significantly improved.For PE,after anticoagulant therapy,the patient’s breathing was stable and blood oxygen saturation was normal.For deep venous thrombosis of both lower extremities,anticoagulant therapy was continued.Conclusion:patients with thrombophilia are prone to cerebral embolism,PE and deep venous thrombosis of lower limbs.Intravenous thrombolytic therapy in acute phase and heparin anticoagulant therapy in recovery period can effectively control the disease.

阿替普酶静脉溶栓治疗脑梗死患者的再闭塞影响因素及替罗非班治疗效果

目的探讨脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素及替罗非班的治疗效果。方法选取100例脑梗死患者作为研究对象,根据阿替普酶静脉溶栓后是否再闭塞分为闭塞组(n=42)和非闭塞组(n=58)。闭塞组给予替罗非班治疗。比较2组一般资料。采用Logistic回归模型分析脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素。观察闭塞组治疗总有效率、重组人组织型纤溶酶原激酶衍生物(rPA)、纤溶酶原激活物抑制剂1(PAI-1)水平以及美国国立卫生研究院卒中量表(NIHSS)、简易精神状态量表(MMSE)评分。结果2组在2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间方面比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间是脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素(P<0.05)。42例溶栓后再闭塞患者经替罗非班治疗后总有效率为88.10%(37/42)。治疗3、7 d,rPA高于治疗前,PAI-1低于治疗前,差异有统计学意义(P<0.05);治疗1、2、4周,MMSE评分高于治疗前,NIHSS评分低于治疗前,差异有统计学意义(P<0.05)。结论2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间可对脑梗死患者阿替普酶静脉溶栓后再闭塞产生影响。再闭塞后予以替罗非班治疗的效果较为理想,有利于改善患者神经功能与rPA、PAI-1水平。

急性脑梗死介入治疗联合静脉溶栓治疗的效果观察

目的 探究介入治疗联合静脉溶栓对急性脑梗死患者的治疗效果。方法 80例急性脑梗死患者,合理且随机划分为对照组和观察组,每组40例。对照组采取静脉溶栓治疗,观察组在对照组基础上采用介入治疗。比较两组患者神经功能缺损评分、血清学相关指标(神经生长因子、神经元特异性烯醇化酶、脑钠肽)、活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原、并发症发生情况。结果 观察组患者治疗后1 d、7 d、2周神经功能缺损评分均低于对照组(P<0.05)。治疗后,两组患者神经生长因子、神经元特异性烯醇化酶、脑钠肽水平均下降,且观察组患者神经生长因子(95.31±9.65)ng/ml、神经元特异性烯醇化酶(10.26±1.37)μg/L、脑钠肽(157.43±13.25)ng/L均低于对照组的(116.38±10.46)ng/ml、(15.86±1.86)μg/L、(189.46±17.78)ng/L(P<0.05)。治疗后,观察组患者活化部分凝血活酶时间(35.43±2.21)s、凝血酶原时间(13.26±1.53)s、凝血酶时间(17.46±2.24)s比对照组的(30.48±2.15)、(10.93±1.29)、(15.55±1.87)s更长,纤维蛋白原(2.44±0.43)g/L比对照组的(4.21±0.64)g/L更低(P<0.05)。观察组并发症发生率5.00%比对照组的25.00%更低(P<0.05)。结论 针对急性脑梗死患者,采取静脉溶栓联合介入治疗可有效改善患者神经功能及血清学状况,且可以有效改善活化部分凝血活酶时间等相关临床指标,减少相关并发症的发生,该治疗方案临床应用效果理想,预后效果良好,值得在临床广泛推广。

急性脑梗死静脉溶栓治疗短期预后不良预测模型的建立及验证

目的评估入院指标与急性脑梗死溶栓治疗患者短期临床预后的相关性,建立并验证预后不良的预测模型。方法回顾性分析2020-01—2023-12河南大学第一附属医院的165例急性脑梗死溶栓治疗患者的资料。根据溶栓90 d后改良Rankin量表(mRS)评分将患者分为预后良好组及预后不良组,并进行组间单因素分析和多因素Logistic回归分析,分析血清生物学标志物联合相关临床评估量表与急性脑梗死溶栓治疗患者预后的关系,建立预后预测模型并进行验证。结果共纳入165例患者,预后良好126例,预后不良39例。单因素分析和多因素Logistic回归分析显示,糖尿病史、高NIHSS评分及白细胞、中性粒细胞、D-二聚体升高是急性脑梗死溶栓治疗患者90 d预后不良的独立预测因子。ROC曲线分析表明,糖尿病史、NIHSS评分、白细胞、中性粒细胞、D-二聚体评估急性脑梗死患者90 d预后不良的曲线下面积(AUC)分别0.677、0.826、0.876、0.765、0.863,灵敏度分别为51.3%、82.1%、89.7%、79.5%、79.5%,特异度分别为84.1%、77.8%、77.8%、64.3%、86.5%。以上指标联合构建预后预测模型,该模型具有较好的区分度、临床可用性和校准度。结论结合独立预测因子建立的预后不良风险预测模型清晰简易,可在患者入院时准确预测患者预后,帮助临床早期选择合理干预措施,改善患者预后。

血清Cx43、Gal-9水平对老年急性脑梗死患者超早期静脉溶栓治疗预后的评估价值

目的探讨血清间隙连接蛋白43(Cx43)、半乳糖凝集素-9(Gal-9)水平对老年急性脑梗死(ACI)患者超早期静脉溶栓治疗预后的评估价值。方法选取2020年9月至2022年9月在该院行超早期静脉溶栓治疗的106例老年ACI患者作为研究组,另外选取同期来该院体检的100例体检健康者作为健康组。采用酶联免疫吸附试验(ELISA)检测所有研究对象的血清Cx43、Gal-9水平。治疗2周后参考美国国立卫生院卒中量表(NIHSS)评分将106例老年ACI患者分为预后良好组(81例)与预后不良组(25例)。采用受试者工作特征(ROC)曲线分析血清Cx43、Gal-9水平对老年ACI患者超早期静脉溶栓治疗预后的评估价值,采用多因素Logistic回归分析探讨老年ACI患者超早期静脉溶栓治疗预后不良的影响因素。结果研究组血清Cx43、Gal-9水平高于健康组(P<0.05);预后不良组血清Cx43、Gal-9水平高于预后良好组(P<0.05);血清Cx43、Gal-9预测老年ACI患者预后不良的曲线下面积(AUC)分别为0.721(95%CI:0.673~0.758)、0.837(95%CI:0.787~0.886),二者联合预测的AUC为0.901(95%CI:0.857~0.946)。预后不良组高血压占比高于预后良好组(P<0.05);多因素Logistic回归分析显示,高血压(OR=3.487,95%CI:1.564~7.773),血清Cx43≥106.53 pg/mL(OR=4.586,95%CI:1.982~10.611),血清Gal-9≥11.84 ng/mL(OR=4.345,95%CI:1.957~9.648)是老年ACI患者超早期静脉溶栓治疗预后不良的危险因素(P<0.05)。结论血清Cx43、Gal-9在老年ACI患者中均呈高表达,可用于评估老年ACI患者超早期静脉溶栓治疗的预后,二者联合检测的评估价值更高。

丁苯酞联合溶栓治疗急性脑梗死的疗效及不良预后相关分析

目的 探索丁苯酞联合溶栓治疗急性脑梗死的疗效及影响预后不良的独立因素。方法 选取的80例急性脑梗死患者均行丁苯酞联合溶栓治疗,治疗14 d。比较治疗前、治疗后7 d及14 d的神经功能、生活质量,且采用酶联免疫吸附法测定血清指标,经颅多普勒超声评估大脑中动脉的峰流速和平均流速。同时,根据预后情况分为两组,以改良Rankin量表(mRS)评分为判定标准,mRs评分0~2分为预后良好,mRs评分≥3分为预后不良,经二元Logistic回归分析影响预后的独立因素。结果 患者治疗后的Barthel指数(BI)评分、大脑中动脉峰值、大脑中动脉平均流速高于治疗前,C反应蛋白(CRP)、尿酸(UA)、肌酸激酶(CK)、脑钠肽(BNP)、美国国立卫生研究院卒中量表(NIHSS)评分、mRs评分低于治疗前(P<0.05)。经单因素分析,年龄、溶栓后出血、溶栓前血糖、发病至溶栓时间、梗死部位、入院时血压异常会对预后造成影响(P<0.05),经二元Logistic回归分析,年龄>70岁、发病至溶栓时间≥3 h、入院时血压异常是影响患者预后的独立因素。结论 丁苯酞联合溶栓治疗急性脑梗死患者效果显著,可促进神经功能恢复,改善脑部血流动力学,但预后受发病至溶栓时间、年龄、血压等因素影响。

针刺联合息风化痰通络颗粒对急性脑梗死溶栓患者的影响及机制研究

目的:评估针刺联合息风化痰通络颗粒对急性脑梗死(ACI)后溶栓患者的疗效,探讨其作用机制。方法:纳入ACI溶栓患者178例,按随机数字表法分为观察组和对照组各89例,最终164例完成研究,观察组81例,对照组83例。对照组接受常规治疗,观察组在对照组的基础上加用针刺联合息风化痰通络颗粒治疗,两组均治疗2周。评估比较两组的临床疗效、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(ADL)评分、血清炎症因子水平、氧化应激因子水平以及脑血流动力学。结果:治疗后,两组ADL评分、白细胞介素-10(IL-10)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)水平均较治疗前升高(P<0.05),NIHSS评分、白细胞介素-1β(IL-1β)、超敏C反应蛋白(hs-CRP)、丙二醛(MDA)水平较治疗前降低(P<0.05),观察组NIHSS评分、IL-1β、IL-10、hs-CRP、MDA水平低于对照组(P<0.05),ADL评分、SOD、GSH-Px、CAT水平高于对照组(P<0.05)。两组脑血流动力学指标均较治疗前改善,且观察组改善情况优于对照组(P<0.05)。观察组治疗总有效率95.06%,对照组84.34%,两组疗效比较,差异有统计学意义(P<0.05)。结论:针刺联合息风化痰通络颗粒能够促进ACI溶栓患者脑血流动力学恢复,改善缺血再灌注损伤的神经功能,其作用机制可能与减轻炎症反应、抑制氧化应激反应有关。

介入溶栓治疗颅内大血管狭窄急性闭塞致脑梗死的疗效及对患者血清BDNF GAP-43和NGF的影响

目的 探讨介入溶栓治疗颅内大血管狭窄急性闭塞致脑梗死的临床疗效及对患者血清脑源性神经营养因子(BDNF)、神经生长相关蛋白43(GAP-43)和神经生长因子(NGF)水平的影响。方法 将56例颅内大血管狭窄急性闭塞致脑梗死患者按治疗方法分为对照组(28例)和研究组(28例)。对照组患者给予常规治疗,研究组患者在对照组基础上给予介入溶栓治疗。比较两组临床疗效以及不良事件发生率,比较治疗前后两组患者美国国立卫生研究院卒中量表(NHISS)评分、脑血流灌注指标、生存质量综合评定问卷简表(WHOQOL-BREF)评分及血清BDNF、GAP-43和NGF水平。结果 治疗后两组患者NHISS评分均较治疗前降低,且研究组低于对照组(P<0.01);治疗后两组患者脑血流量(CBF)、脑血容量(CBV)、脑血流平均通过时间(MTT)均较治疗前升高,且研究组高于对照组(P<0.01)。治疗后,研究组患者WHOQDL-BREF各维度评分均高于对照组(P<0.01)。治疗后,两组患者血清BDNF、GAP-43和NGF水平均较治疗前升高,且研究组高于对照组(P<0.01)。研究组患者临床总有效率高于对照组(P<0.05),两组患者不良事件发生率比较差异无统计学意义(P>0.05)。结论 介入溶栓治疗颅内大血管狭窄急性闭塞致脑梗死能够显著改善患者神经缺损程度,改善脑部供血,提高其生活质量,疗效显著。

血清髓鞘碱性蛋白表达与急性脑梗死患者rt-PA静脉溶栓后出血转化的关系

目的 探讨血清髓鞘碱性蛋白(MBP)表达与急性脑梗死(ACI)患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后出血转化(HT)的关系。方法 前瞻性纳入2019年5月至2021年12月商丘市第一人民医院收治的105例ACI患者为研究对象,患者均接受rt-PA静脉溶栓治疗,并根据治疗后24 h内HT发生情况分为HT组与无HT组,比较两组一般资料、治疗前血清MBP水平及其他实验室指标,重点分析血清MBP与ACI患者rt-PA静脉溶栓后HT发生的关系。结果 105例患者中15例存在HT,发生率为14.29%;HT组溶栓治疗前美国国立卫生院卒中量表(NIHSS)评分高于无HT组,发病至治疗时间长于无HT组,血清MBP水平高于无HT组,差异有统计学意义(P<0.05);点二列相关性分析显示,血清MBP与ACI患者rt-PA静脉溶栓后HT发生有关(P<0.05);多因素logistic分析发现,溶栓治疗前NIHSS评分、发病至治疗时间、血清MBP水平均是ACI患者rt-PA静脉溶栓后HT发生的影响因素(P<0.05);受试者工作特征曲线分析发现,血清MBP预测ACI患者rt-PA静脉溶栓后HT发生的曲线下面积为0.740(95%CI:0.606~0.874),具有一定预测价值。结论 血清MBP水平与ACI患者rt-PA静脉溶栓后HT发生密切相关,可作为临床早期预测患者rt-PA静脉溶栓后HT发生风险的辅助指标。

优化溶栓护理流程联合超早期个性化护理对急性脑梗死溶栓患者康复效果及并发症的影响

目的探讨优化溶栓护理流程联合超早期个性化护理应用于急性脑梗死溶栓患者的临床效果。方法80例急性脑梗死溶栓患者随机分为两组,参照组予以常规护理,观察组予以优化溶栓护理流程联合超早期个性化护理干预,比较两组的康复效果和并发症。结果护理后,观察组的NIHSS评分低于参照组,Barthel评分高于参照组,并发症总发生率低于参照组(P<0.05)。结论优化溶栓护理流程联合超早期个性化护理可明显提高急性脑梗死溶栓患者的康复效果,降低并发症发生风险。

ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性

目的探讨急性脑梗死(ACI)溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性。方法选取2018年12月至2022年12月于新疆维吾尔自治区人民医院接受治疗的患者148例为观察组,同时健康体检正常者148例为对照组,均采用实时荧光定量PCR法检测血清miR-379-5p表达水平并对比。根据血清miR-379-5p表达水平情况将观察组进行亚分组,根据中位数分为高表达组和低表达组,对比观察组中高表达组和低表达组一般资料、缺血再灌注损伤水平,采用Pearson分析ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性。结果观察组miR-379-5p表达水平(1.09±0.24)较对照组miR-379-5p表达水平(1.88±0.21)低(t=30.137,P<0.01)。根据观察组miR-379-5p表达水平中位数分组分为高表达组74例(miR-379-5p表达水平≥1.10)和低表达组74例(miR-379-5p表达水平<1.10);高表达组溶栓后NIHSS评分、血清晚期氧化蛋白产物(AOPP)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、单核细胞趋化蛋白-1(MCP-1)水平较低表达组低,血清过氧化物歧化酶(SOD)水平较低表达组高(P<0.05);Pearson相关性分析显示:miR-379-5p表达水平与溶栓后NIHSS评分、血清AOPP、MDA、TNF-α、CRP及MCP-1水平(r=-0.465,P<0.05;r=-0.273,P<0.05;r=-0.429,P<0.05;r=-0.486,P<0.05;r=-0.320,P<0.05;r=-0.273,P<0.05)呈负相关,与血清SOD水平呈正相关(r=-0.465,P<0.05)。结论ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性,上调miR-379-5p水平有助于减轻ACI静脉溶栓后缺血再灌注损伤。

银丹心脑通软胶囊联合静脉溶栓治疗急性缺血性脑卒中的临床疗效

目的:探讨银丹心脑通软胶囊联合静脉溶栓治疗急性缺血性脑卒中(AIS)患者的临床疗效。方法:选取2022年1月-2023年1月徐州市第一人民医院收治的AIS患者80例为研究对象,根据随机数字表法分为对照组和研究组,各40例。对照组给予静脉溶栓治疗,观察组给予银丹心脑通软胶囊联合静脉溶栓治疗。比较两组患者临床效果。结果:研究组治疗总有效率高于对照组,差异有统计学意义(P=0.004);治疗后,两组甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平均降低,研究组低于对照组,两组高密度脂蛋白胆固醇水平均升高,研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组活化部分凝血酶时间、凝血酶原时间水平均降低,研究组低于对照组,两组纤维蛋白原、D-二聚体水平均升高,研究组高于对照组,差异有统计学意义(P<0.05);治疗后,两组卒中量表、Rankin修订总评分均降低,研究组低于对照组,差异有统计学意义(P<0.05)。结论:AIS患者采用银丹心脑通软胶囊联合静脉溶栓治疗效果显著,可改善患者神经功能缺损、病残程度、血脂水平及凝血功能。

急性脑梗死静脉溶栓患者的CRP、NLR和LER动态变化及其对预后的预测价值

目的探讨急性脑梗死(ACI)静脉溶栓患者的C反应蛋白(CRP)、中性粒细胞和淋巴细胞比值(NLR)及白细胞和红细胞计数比值(LER)的动态变化及其对患者预后的预测价值。方法选择商丘市第一人民医院2020年2月至2023年2月急诊就诊的ACI且在院进行静脉溶栓治疗的126例患者。根据发病后90 d改良Rankin量表评分(mRS)将所有患者分为预后良好组(94例)及预后不良组(32例)。比较两组溶栓前、溶栓后1 d、溶栓后7 d的CRP、NLR、LER的变化情况及发病90 d的mRS评分。采用Cox回归分析影响ACI静脉溶栓患者预后的相关因素。采用Spearman相关性分析CRP、NLR、LER水平与ACI静脉溶栓患者mRS评分的相关性。采用受试者工作特征(ROC)曲线分析溶栓后1 d及7 d的CRP、NLR、LER的变化情况对ACI静脉溶栓患者预后的预测价值。结果重复测量方差分析显示,两组CRP、NLR、LER在时间效应、组间效应及交互效应均有统计学意义(P<0.05);简单效应分析,预后良好组患者溶栓后1 d及7 d的CRP、NLR、LER水平低于预后不良组(P<0.05)。预后良好组发病90 d的mRS评分分布优于预后不良组(P<0.05)。Cox回归分析结果显示溶栓后1 d及7 d的CRP、NLR、LER水平均是ACI静脉溶栓患者预后的相关影响因素。Spearman相关性分析示,溶栓后1 d及7 d的CRP、NLR、LER水平与ACI静脉溶栓患者发病90 d的mRS评分呈正相关(r=0.405、0.481、0.518、0.680、0.530、0.504,P<0.05)。ROC曲线结果显示溶栓后7 d的CRP、NLR、LER及三者联合的曲线下面积(AUC)均大于溶栓后1 d的各项对应指标及联合指标的AUC,溶栓后7 d各项指标联合预测ACI静脉溶栓患者预后的AUC最大,为0.856。结论ACI静脉溶栓患者的CRP、NLR、LER随患者病情改善呈逐渐下降趋势,且与患者的预后相关,3种指标联合检测对ACI静脉溶栓患者预后的预测价值更高。

分析标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的临床效果

目的 探究标准剂量rt-PA静脉溶栓联合动脉取栓治疗急性脑梗死的效果。方法 随机选取海阳市人民医院于2021年7月—2023年7月收治的80例急性脑梗死患者为研究对象,通过随机数表法分成溶栓组与桥接组,各40例。溶栓组运用标准量静脉溶栓治疗,桥接组在经过30 min静脉溶栓治疗之后,对治疗效果不理想的患者,进行机械取栓。比较两组的国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分以及不良反应发生情况。结果 治疗后24 h、7 d、30 d,桥接组的NIHSS评分均低于溶栓组,差异有统计学意义(P均<0.05)。桥接组的不良反应总发生率为7.50%,溶栓组为2.50%,两组对比,差异无统计学意义(χ^(2)=0.263,P>0.05)。结论 标准剂量rt-PA静脉溶栓联合动脉取栓治疗有效地促进了患者神经功能的恢复,不良反应与溶栓治疗相当,对急性脑梗死的治疗提供了有力的支持。