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.

A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.

Intracranial hematoma development following thrombolysis inpatients suffering with acute myocardial infarction: Management strategy

Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial 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.

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.

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.

Early and Late Coronary Angiographic Changes After Thrombolysis in Acute Myocardial Infarciton

Objective The coronaryanatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied. Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG) was performed at 90 minuts and again at 3 to 4 weeks. Results Successful thrombolysis occurred in 60 cases, but failed in 40. The ratio of reperfusion was 60%. CAG showed there were residual thrombi in 84 patients (84% ) and complete coronary occlusion in 40(40% ). Angiography at 3 to 4 weeks after thrombolysis showed the stenosis worsened in 8 patients and improved in 10. Conclusion AMI is caused by sudden coronary thrombotic occlusion and can be reperfused by using thrombolytic agent or mechanical methods. Throm-bolytic agents usually can not resolve thrombi completely. So percutaneous transluminal coronary angiography (PTCA) is recommended as an important method to improve serious residual stenosis.

Effect of transplantation of bone marrow stem cells on myocardial infarction size in a rabbit model

BACKGROUND:Intravenous transplantation has been regarded as a most safe method in stem cell therapies.There is evidence showing the homing of bone marrow stem cells(BMSCs) into the injured sites,and thus these cells can be used in the treatment of acute myocardial infarction(Ml).This study aimed to investigate the effect of intravenous and epicardial transplantion of BMSCs on myocardial infarction size in a rabbit model.METHODS:A total of 60 New Zealand rabbits were randomly divided into three groups:control group,epicardium group(group Ⅰ) and ear vein group(group Ⅱ).The BMSCs were collected from the tibial plateau in group Ⅰ and group Ⅱ,cultured and labeled.In the three groups,rabbits underwent thoracotomy and ligation of the middle left anterior descending artery.The elevation of ST segment>0.2 mV lasting for 30 minutes on the lead Ⅱ and Ⅲ of electrocardiogram suggested successful introduction of myocardial infarction.Two weeks after myocardial infarction,rabbits in group Ⅰ were treated with autogenous BMSCs at the infarct region and those in group Ⅱ received intravenous transplantation of BMSCs.In the control group,rabbits were treated with PBS following thoracotomy.Four weeks after myocardial infarction,the heart was collected from all rabbits and the infarct size was calculated.The heart was cut into sections followed by HE staining and calculation of infarct size with an image system.RESULTS:In groups Ⅰ and Ⅱ,the infarct size was significantly reduced after transplantation with BMSCs when compared with the control group(P<0.05).However,there was no significant difference in the infarct size between groups Ⅰ and Ⅱ(P>0.05).CONCLUSION:Transplantation of BMSCs has therapeutic effect on Ml.Moreover,epicardial and intravenous transplantation of BMSCs has comparable therapeutic efficacy on myocardial infarction.

PROCOAGULANT EFFECTS OF THROMBOLYTIC THERAPY IN ACUTE MOCARDIAL INFARCTION

Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute myocardial infarction(AMI) received 1.5 or 2.0 mulliou U nonspecific urokinase(UK),or 70-80 mg fibrin-specific fecombinant tissue plasminogen activator(rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents.Eight patients with AMI an without thrombolytic therapy were enrolled as controls.Coagulant and thrombolytic activity markers included thrombin-antithrombin Ⅲ comlex(TAT),D-dimer,fibrinogen(Fg) ,FMPV/Amax.All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic agents respectively.Results.Molecular marker of thrombin generation-TAT showed an activated coagulant state immediately after thrombolytic therapy.Level of TAT showed no significant changes between every two osbserved phases in controls.Howver,level of TAT increased significantly from 4.95±1.75μg/L(4.63±1.37μg/L) to 14.71±3.31μg/L(14.25±2.53μg/L) before and immediately after administration of thrombolytic agents UK(or rt-PA).There was significant difference between level of serum TAT of patients with and without thrombolytic therapy,and higher EMPV/Amax level than controls.D-dimer,a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therap(P<0.05).Couclusions.Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy.Both urokinase and rt-PA had procoagulant action.This transient activation of the coagulant system might contribute to early reocclusion.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.

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。

血清HDAC4和MYD88水平与急性脑梗死rt-PA静脉溶栓后出血转化的关系研究

目的探讨急性脑梗死(ACI)患者血清组蛋白去乙酰化酶4(HDAC4)和髓样分化蛋白88(MYD88)水平与重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生出血转化的关系。方法选取2020年5月至2022年5月在该院就诊并进行rt-PA静脉溶栓治疗的169例ACI患者作为研究对象,并根据患者进行rt-PA静脉溶栓后是否发生出血转化将其分为转化组(46例)和非转化组(123例),另外选取同期在该院进行体检的156例体检健康者作为对照组。采用酶联免疫吸附试验对各组血清HDAC4、MYD88水平进行检测,并对转化组和非转化组的一般资料进行比较;采用Pearson相关对ACI患者血清HDAC4和MYD88水平的相关性进行分析;采用多因素Logistic回归分析影响ACI患者rt-PA静脉溶栓后出血转化的相关因素;进一步通过受试者工作特征(ROC)曲线评估HDAC4、MYD88水平及二者联合对ACI患者rt-PA静脉溶栓后出血转化的诊断价值。结果ACI组血清HDAC4水平低于对照组,血清MYD88水平高于对照组,差异均有统计学意义(P<0.05);非转化组和转化组ACI患者的性别、年龄、体重指数、空腹血糖及高血脂、冠心病占比比较,差异均无统计学意义(P>0.05),而患者心房颤动占比、美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间比较,差异均有统计学意义(P<0.05);转化组较非转化组血清HDAC4水平降低,血清MYD88水平升高,差异有统计学意义(P<0.05);Pearson相关分析结果显示,ACI患者血清HDAC4水平与MYD88呈负相关(r=-0.401,P<0.001);多因素Logistic回归分析显示,心房颤动、发病至溶栓时间、NIHSS评分、MYD88水平是ACI患者rt-PA静脉溶栓后发生出血转化的危险因素,HDAC4水平是ACI患者rt-PA静脉溶栓后发生出血转化的保护因素(P<0.05);血清HDAC4、MYD88联合检测ACI患者rt-PA静脉溶栓后发生出血转化的曲线下面积为0.876,灵敏度和特异度分别为65.22%和98.37%,优于HDAC4和MYD88单独诊断(Z二者联合-HDAC4=2.298,P=0.022;Z二者联合-MYD88=2.545,P=0.011)。结论ACI患者血清HDAC4和MYD88水平与rt-PA静脉溶栓后发生出血转化密切相关。

Th17/Treg与急性脑梗死患者rt-PA溶栓后脑出血发生的相关性

目的分析辅助性T细胞17(Th17)/调节性T细胞(Treg)与急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗后脑出血发生的相关性。方法本研究为前瞻性分析,纳入2021年2月至2023年2月收治的急性脑梗死患者,所有患者行rt-PA溶栓治疗。检测患者溶栓治疗前、后Th17、Treg细胞含量,计算Th17/Treg水平。根据溶栓治疗后复查CT/MRI结果,将患者分为脑出血组和未出血组。采用点二列相关性检验Th17/Treg与急性脑梗死患者rt-PA溶栓治疗后脑出血发生的关系,绘制受试者工作特征曲线分析治疗前Th17/Treg对急性脑梗死患者rt-PA溶栓治疗后脑出血发生的预测价值。结果共纳入403例急性脑梗死患者,其中12例rt-PA溶栓治疗后发生脑出血,占2.98%。治疗前,脑出血组患者Th17/Treg高于未出血组(P<0.05);治疗后,2组患者Th17/Treg较治疗前降低,且脑出血组患者Th17/Treg高于未出血组,差异有统计学意义(P<0.05)。经点二列相关性分析,Th17/Treg与急性脑梗死患者rt-PA溶栓治疗后脑出血发生呈正相关(r=0.217,P<0.001)。绘制受试者工作特征曲线,Th17/Treg对急性脑梗死患者rt-PA溶栓治疗后脑出血发生有一定预测价值(AUC=0.809,P<0.001)。结论Th17/Treg指标与急性脑梗死患者rt-PA溶栓治疗后脑出血发生有关,且能预测治疗后脑出血发生情况。

rt-PA静脉溶栓联合丁苯酞对急性脑梗死患者的疗效分析

目的:探讨阿替普酶(rt-PA)静脉溶栓联合丁苯酞用于急性脑梗死(acute cerebral infarction,ACI)患者治疗中的临床效果。方法:以2022年1月—2023年6月瑞金市人民医院收治的ACI患者82例为研究对象,按随机数字表法分为对照组(脑梗死常规治疗+rt-PA静脉溶栓)、观察组(在对照组基础上联合应用丁苯酞),每组41例。观察对比两组神经功能缺损程度、生活自理能力、临床疗效、血清指标、不良反应发生率及生活质量评分。结果:治疗后两组美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分较治疗前均降低,日常生活活动能力量表(activities of daily living,ADL)、健康调查简易量表(SF-36)评分较治疗前均升高,且观察组均优于对照组,差异均有统计学意义(P<0.05);观察组临床总有效率高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率对比,差异无统计学意义(P>0.05);治疗后两组脑钠肽(brain natriuretic peptide,BNP)、同型半胱氨酸(homocysteine,Hcy)、C反应蛋白(C reactive protein,CRP)水平均较治疗前降低,且观察组均低于对照组,差异均有统计学意义(P<0.05)。结论:ACI患者应用rt-PA静脉溶栓联合丁苯酞治疗,临床效果确切,且安全性高,可促进神经功能恢复,改善预后。

丁苯酞注射液对急性脑梗死rt-PA静脉溶栓患者的应用研究

目的:探讨丁苯酞注射液对急性脑梗死重组人组织型纤溶酶原激活物(rt-PA)静脉溶栓患者炎性反应及血管内皮功能的影响。方法:纳入医院收治的60例急性脑梗死患者作为研究对象,随机分作予以rt-PA静脉溶栓治疗的对照组以及辅以丁苯注射液治疗的观察组,比较两组神经功能、炎性反应、血管内皮功能及安全性。结果:经治疗后,两组患者NIHSS、NSE均有降低,观察组患者低于对照组(P<0.05);两组患者hs-CRP、sICAM-1均见下降,观察组患者低于对照组(P<0.05);两组患者ET-1、MDA均见下降,观察组患者低于对照组(P<0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:丁苯酞注射液治疗急性脑梗死rt-PA静脉溶栓患者,可以促进其神经功能恢复,减轻炎性反应,增强血管内皮功能,且不增加不良反应发生风险,具有较高安全性。

rt-PA静脉溶栓与丁苯酞注射液治疗急性脑梗死的疗效探究

目的研究重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓与丁苯酞注射液治疗急性脑梗死的疗效。方法100例急性脑梗死患者,应用随机数字表法分为对照组和研究组,每组50例。对照组患者采用rt-PA开展静脉溶栓治疗,研究组患者先给予丁苯酞注射液,再采用rt-PA开展静脉溶栓治疗。对比两组治疗前后血液流变学指标、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分及出血事件发生率。结果对比本组治疗前,两组治疗后全血高切粘度、全血低切粘度、血浆粘度、红细胞压积均明显降低,且研究组全血高切粘度(4.20±0.54)mPa·s、全血低切粘度(10.05±0.98)mPa·s、血浆粘度(1.39±0.40)mPa·s、红细胞压积(31.28±2.36)%均低于对照组的(4.81±0.59)mPa·s、(11.20±1.13)mPa·s、(1.87±0.45)mPa·s、(34.59±3.04)%(P<0.05)。对比本组治疗前,两组治疗后NIHSS评分、mRS评分均明显降低,且研究组NIHSS评分(9.12±2.74)分、mRS评分(1.89±0.62)分低于对照组的(12.54±3.05)、(2.65±0.74)分(P<0.05)。研究组出血事件发生率4.00%低于对照组的18.00%(P<0.05)。结论对于接受静脉溶栓治疗的急性脑梗死患者,在采用rt-PA开展静脉溶栓治疗前应用丁苯酞注射液,可更加有效地改善患者血液流变学,有利于增强神经功能修复效果,改善其预后,还可减少出血事件发生,提高静脉溶栓治疗的安全性。

急性大脑中动脉M1段闭塞脑梗死患者低剂量rt-PA静脉溶栓后桥接取栓与直接动脉取栓的临床价值

目的探讨急性大脑中动脉M1段闭塞脑梗死患者低剂量rt-PA静脉溶栓后桥接取栓与直接动脉取栓的临床价值。方法选取2021年6月至2022年6月景德镇市第一人民医院收治的80例急性大脑中动脉M1段闭塞脑梗死患者作为研究对象,根据患者及家属意愿分为A组与B组,每组40例。A组行直接动脉取栓治疗,B组行静脉溶栓后桥接动脉取栓治疗。比较两组血管开通率、病死率、不良事件发生率、美国国立卫生院卒中量表(NIHSS)及改良Rankin评分量表(mRS)评分。结果B组血管开通率高于A组,差异有统计学意义(P<0.05)。两组不良事件总发生率比较差异无统计学意义。治疗前、治疗后24 h,两组NIHSS评分比较差异无统计学意义;治疗后3、7 d,B组NIHSS评分均低于B组,差异有统计学意义(P<0.05)。治疗3个月后,B组mRS评分低于A组,差异有统计学意义(P<0.05)。两组病死率比较差异无统计学意义。结论低剂量rt-PA静脉溶栓后桥接动脉取栓治疗急性大脑中动脉M1段闭塞脑梗死安全、有效,可提高血管开通率,且可改善患者预后,值得临床推广应用。

急性脑梗死患者rt-PA静脉溶栓后脑出血转化与血清TXB2、sICAM-1、PTX3水平的相关性研究

目的探讨血清血栓素B2(TXB2)、可溶性细胞间黏附分子-1(sICAM-1)、正五聚体蛋白3(PTX3)水平变化对急性脑梗死(ACI)患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后脑出血转化的影响。方法选取本院收治的82例ACI患者为研究对象,rt-PA静脉溶栓后24 h行CT检查,依据是否发生脑出血转化将其分为转化组和非转化组。分析溶栓后脑出血转化的相关影响因素及溶栓后12 h血清TXB2、sICAM-1、PTX3对脑出血转化的预测价值。结果82例患者中,20例发生脑出血转化,62例未发生脑出血转化。转化组的溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、总胆固醇、纤维蛋白原水平高于非转化组(P<0.05)。溶栓后12、24 h,非转化组的血清TXB2、sICAM-1、PTX3水平低于转化组(P<0.05)。Logistic回归分析结果显示,溶栓前NIHSS评分、TXB2、sICAM-1、PTX3为溶栓后脑出血转化的相关危险因素(P<0.05)。血清TXB2、sICAM-1、PTX3联合预测脑出血转化的曲线下面积(AUC)大于单项预测(P<0.05)。结论溶栓前NIHSS评分及血清TXB2、sICAM-1、PTX3为ACI患者接受rt-PA静脉溶栓后发生脑出血转化的危险因素,而血清TXB-2、sICAM-1、PTX3联合检测对脑出血转化具有较高的预测效能。

rt-PA静脉溶栓治疗伴有HMCAS急性脑梗死患者的临床效果及对血清t-PA、PAI-1水平和免疫功能的影响

目的探讨重组组织型纤溶酶原激活物(rt-PA)治疗伴有大脑中动脉高密度征(HMCAS)急性脑梗死患者的临床效果及对血清组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物1(PAI-1)水平和免疫功能的影响。方法选取2020年3月至2022年6月在我院治疗的132例伴有HMCAS急性脑梗死患者的临床资料进行研究,根据治疗方案将其分为对照组(n=66)和观察组(n=66)。对照组给予常规治疗,观察组在此基础上给予rt-PA静脉溶栓治疗。比较两组的治疗效果。结果治疗7 d后,两组的美国国立卫生研究院卒中量表(NIHSS)评分均降低,且观察组显著低于对照组(P<0.05)。治疗7 d后,观察组的t-PA水平显著高于对照组,PAI-1水平显著低于对照组(P<0.05)。治疗7 d后,两组的CD3^(+)、CD4^(+)、免疫球蛋白G(IgG)和免疫球蛋白M(IgM)水平高于治疗前,且观察组显著高于对照组(P<0.05)。观察组的Barthel指数评分、改良Rankin量表(mRS)评分0~2分占比明显高于对照组(P<0.05)。结论rt-PA静脉溶栓治疗伴有HMCAS急性脑梗死效果较好,可有效改善患者t-PA、PAI-1水平,提升免疫功能,且安全性较高。

急性脑梗死患者rt-PA静脉溶栓治疗预后情况及相关影响因素分析

目的探讨急性脑梗死患者阿替普酶(rt-PA)静脉溶栓治疗的预后情况,并分析其相关影响因素。方法将120例急性脑梗死患者随机分为对照组(60例)和观察组(60例)。对照组予以常规治疗,观察组在对照组基础上予以rt-PA静脉溶栓治疗,比较两组患者治疗后3个月的神经功能(NIHSS评分)、日常活动能力(BI评分)及预后情况(m RS评分)。根据mRS评分将观察组分为预后良好和预后不佳两个亚组,并通过单、多因素Logistic模型分析影响其预后的相关因素。结果治疗后3个月,观察组的NIHSS、mRS评分低于对照组,BI评分高于对照组(P<0.05)。观察组预后良好53例,预后不佳7例;经单因素和多因素Logistic分析显示,心脏疾病史、糖尿病、营养状况是影响观察组患者预后的独立因素(P<0.05)。结论rt-PA静脉溶栓治疗有利于急性脑梗死患者预后恢复,而心脏疾病史、糖尿病、营养不良会影响其预后情况。