机械支架介入取栓联合静脉溶栓治疗老年急性脑梗死临床疗效及对患者神经功能的影响
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摘要
目的:对比机械支架介入取栓联合静脉溶栓与动静脉联合溶栓治疗老年急性脑梗死(ACI)的临床效果及对患者神经功能影响。方法:采用随机数字分组方式将120例入选的ACI患者均分为两组,对照组在常规对症处理基础上实施rt-PA动静脉联合溶栓治疗;观察组则在rt-PA动脉溶栓基础上,实施机械支架介入取栓治疗。对比两组治疗1个月后临床效果及TIMI血流分级情况;评估两组治疗前及治疗后1个月NIHSS和mRS评分,测定其血清骨桥蛋白(OPN)、氨基末端B型尿钠肽前体(NT-proBNP)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平变化。记录两组治疗期间不良反应情况。结果:观察组ACI患者临床疗效及TIMI血流分级均明显优于对照组(P<0.05)。治疗后1个月,两组NIHSS、mRS评分和血清PON、NT-proBNP、MDA水平均明显降低,血清SOD水平明显升高,且观察组两项神经功能评分及血清学指标变化均明显优于对照组(P<0.05)。两组治疗后24h内颅内症状性出血率间差异无统计学意义(P>0.05)。结论:动脉溶栓治疗后血管未通ACI患者接受机械支架介入取栓治疗可有效促进患者神经功能恢复,调节机体神经功能相关因子表达,抑制机体氧化应激反应,患者TIMI血流分级良好,临床效果显著,安全性高。
Objective:The clinical effect of interventional thrombectomy combined with arteriovenous thrombolysis in the treatment of elderly patients with acute cerebral infarction(ACI)and its influence on neurological function.Methods:120 patients with ACI were divided into two groups by random number grouping.The control group was treated with rt-PA arteriovenous combined thrombolysis on the basis of routine symptomatic treatment.The observation group was treated with mechanical stent intervention and thrombectomy on the basis of rt-PA arterial thrombolysis.The clinical effects and TIMI blood flow grading after 1 month of treatment were compared between the two groups.The NIHSS and mRS scores of the two groups before and 1 month after treatment were evaluated,and the changes of serum OPN,NT-proBNP,SOD and MDA levels were measured.Adverse reactions were recorded during the two treatment periods.Results:The clinical efficacy and TIMI blood flow grading of the observation group were significantly better than those the control group(P<0.05).One month after treatment,the scores of NIHSS,mRS and the levers of serum PON,NT-proBNP and MDA were significantly decreased,and serum SOD levels were significantly increased(P<0.05),and the changes of neurological function scores and serological indexes in the observation group were significantly better than those in the control group(P<0.05).There was no significant difference in intracranial symptomatic bleeding rate between the two groups(P>0.05).Conclusion:Intra-arterial thrombolysis after vascular access to ACI patients undergoing mechanical stent interventional thrombectomy can effectively promote the recovery of neurological function,regulate the expression of neurological function-related factors,inhibit the body's oxidative stress response,patients with TIMI blood flow classification,clinical results are significant,high security.
Objective:The clinical effect of interventional thrombectomy combined with arteriovenous thrombolysis in the treatment of elderly patients with acute cerebral infarction(ACI)and its influence on neurological function.Methods:120 patients with ACI were divided into two groups by random number grouping.The control group was treated with rt-PA arteriovenous combined thrombolysis on the basis of routine symptomatic treatment.The observation group was treated with mechanical stent intervention and thrombectomy on the basis of rt-PA arterial thrombolysis.The clinical effects and TIMI blood flow grading after 1 month of treatment were compared between the two groups.The NIHSS and mRS scores of the two groups before and 1 month after treatment were evaluated,and the changes of serum OPN,NT-proBNP,SOD and MDA levels were measured.Adverse reactions were recorded during the two treatment periods.Results:The clinical efficacy and TIMI blood flow grading of the observation group were significantly better than those the control group(P<0.05).One month after treatment,the scores of NIHSS,mRS and the levers of serum PON,NT-proBNP and MDA were significantly decreased,and serum SOD levels were significantly increased(P<0.05),and the changes of neurological function scores and serological indexes in the observation group were significantly better than those in the control group(P<0.05).There was no significant difference in intracranial symptomatic bleeding rate between the two groups(P>0.05).Conclusion:Intra-arterial thrombolysis after vascular access to ACI patients undergoing mechanical stent interventional thrombectomy can effectively promote the recovery of neurological function,regulate the expression of neurological function-related factors,inhibit the body's oxidative stress response,patients with TIMI blood flow classification,clinical results are significant,high security.
引文
[1]张媛媛,梁荣仙,王敬.急性脑梗死患者氧化低密度脂蛋白、hs-CRP、Hcy、D-二聚体联合检测的临床意义[J].陕西医学杂志,2016,45(10):1396-1398.
[2]雷建明,廖耿,黄伟,等.机械取栓与动静脉联合溶栓治疗急性脑梗死临床效果及预后分析[J].解放军医药杂志,2015,27(4):53-55.
[3]胡静,黄岚.南京地区34家医院溶栓抗凝药物利用分析及合理性评价[J].中国医院药学杂志,2016,36(17):1500-1504.
[4]张小雪,张京芬.国内急性期缺血性脑卒中的溶栓治疗现状分析[J].中华老年心脑血管病杂志,2015,17(2):222-224.
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[6]石宇文,李树欣,谭理连,等.颈内动脉形态异常的对比影像诊断及其与缺血性脑血管病的关系[J].中国临床医学影像杂志,2015,26(4):238-242.
[7]倪贵华,梁晨,赵卫东,等.三种不同血管再通方法治疗椎基底动脉闭塞性脑梗死的疗效对比[J].中华医学杂志,2017,97(13):1001-1005.
[8]王以翠,常焕显,孔令胜.重组组织型纤溶酶原激活剂动脉溶栓联合血管内治疗对早期脑梗死患者的疗效观察[J].中国急救医学,2016,36(7):609-613.
[9]李海军,王长娟,张生,等.参芎葡萄糖注射液联合高压臭氧大自血治疗急性脑梗死患者及对血清CRP的影响[J].陕西中医,2014,35(7):822-823.
[10]崔淑萍.血栓通与舒血宁联合治疗脑梗死60例[J].陕西中医,2009,30(10):1313-1314.
[11]刘越存,刘琦,李红利.机械取栓联合动脉溶栓与动静脉联合溶栓治疗急性脑梗死的疗效比较[J].安徽医学,2014,35(9):1267-1269.
[12]杨云娜,李彤,孙永全,等.Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中疗效观察[J].安徽医学,2015,36(6):669-672.
[13]张颖.急性脑梗死患者急性期血清OPN、氧化应激水平的变化及其与神经损伤和预后的关系[J].广东医学,2017,38(9):1386-1389.
[14]王大正,蔡力,陶剑虹.心力衰竭患者血浆生长分化因子-15、超敏C反应蛋白和氮末端-前体脑钠肽表达水平及其相关性的研究[J].实用医院临床杂志,2013,10(2):39-42.
[15]杨占辉,尹学敬.组织型纤溶酶原激活剂动脉溶栓联合机械取栓治疗急性缺血性脑梗死效果观察[J].临床误诊误治,2018,31(8):45-49.
[16]姜立志,沈丽华,李作汉,等.帕金森病患者氧化应激与运动功能的相关性研究[J].中风与神经疾病,2015,32(12):1092-1094.
[17]马旭东,宋锦宁,张斌飞,等.氢气通过抗氧化应激减轻大鼠弥漫性轴索损伤[J].西安交通大学学报:医学版,2014,35(6):760-766.
[18]傅智轶,刘兴振,吴玉杰,等.硫化氢对急性马尾神经损伤模型大鼠的神经保护作用[J].中国组织工程研究,2014,18(49):7914-7918.
[19]庞红立,关东升.机械介入取栓术联合rt-PA溶栓治疗对急性脑梗死患者血清PON-1、hs-CRP、Lp-PLA2、NSE水平及神经功能评分的影响[J].中国老年学杂志,2018,38(11):2561-2564.
[2]雷建明,廖耿,黄伟,等.机械取栓与动静脉联合溶栓治疗急性脑梗死临床效果及预后分析[J].解放军医药杂志,2015,27(4):53-55.
[3]胡静,黄岚.南京地区34家医院溶栓抗凝药物利用分析及合理性评价[J].中国医院药学杂志,2016,36(17):1500-1504.
[4]张小雪,张京芬.国内急性期缺血性脑卒中的溶栓治疗现状分析[J].中华老年心脑血管病杂志,2015,17(2):222-224.
[5]卢晓喆,黄延焱.急性缺血性脑卒中溶栓治疗[J].中华老年心脑血管病杂志,2014,16(11):1230-1232.
[6]石宇文,李树欣,谭理连,等.颈内动脉形态异常的对比影像诊断及其与缺血性脑血管病的关系[J].中国临床医学影像杂志,2015,26(4):238-242.
[7]倪贵华,梁晨,赵卫东,等.三种不同血管再通方法治疗椎基底动脉闭塞性脑梗死的疗效对比[J].中华医学杂志,2017,97(13):1001-1005.
[8]王以翠,常焕显,孔令胜.重组组织型纤溶酶原激活剂动脉溶栓联合血管内治疗对早期脑梗死患者的疗效观察[J].中国急救医学,2016,36(7):609-613.
[9]李海军,王长娟,张生,等.参芎葡萄糖注射液联合高压臭氧大自血治疗急性脑梗死患者及对血清CRP的影响[J].陕西中医,2014,35(7):822-823.
[10]崔淑萍.血栓通与舒血宁联合治疗脑梗死60例[J].陕西中医,2009,30(10):1313-1314.
[11]刘越存,刘琦,李红利.机械取栓联合动脉溶栓与动静脉联合溶栓治疗急性脑梗死的疗效比较[J].安徽医学,2014,35(9):1267-1269.
[12]杨云娜,李彤,孙永全,等.Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中疗效观察[J].安徽医学,2015,36(6):669-672.
[13]张颖.急性脑梗死患者急性期血清OPN、氧化应激水平的变化及其与神经损伤和预后的关系[J].广东医学,2017,38(9):1386-1389.
[14]王大正,蔡力,陶剑虹.心力衰竭患者血浆生长分化因子-15、超敏C反应蛋白和氮末端-前体脑钠肽表达水平及其相关性的研究[J].实用医院临床杂志,2013,10(2):39-42.
[15]杨占辉,尹学敬.组织型纤溶酶原激活剂动脉溶栓联合机械取栓治疗急性缺血性脑梗死效果观察[J].临床误诊误治,2018,31(8):45-49.
[16]姜立志,沈丽华,李作汉,等.帕金森病患者氧化应激与运动功能的相关性研究[J].中风与神经疾病,2015,32(12):1092-1094.
[17]马旭东,宋锦宁,张斌飞,等.氢气通过抗氧化应激减轻大鼠弥漫性轴索损伤[J].西安交通大学学报:医学版,2014,35(6):760-766.
[18]傅智轶,刘兴振,吴玉杰,等.硫化氢对急性马尾神经损伤模型大鼠的神经保护作用[J].中国组织工程研究,2014,18(49):7914-7918.
[19]庞红立,关东升.机械介入取栓术联合rt-PA溶栓治疗对急性脑梗死患者血清PON-1、hs-CRP、Lp-PLA2、NSE水平及神经功能评分的影响[J].中国老年学杂志,2018,38(11):2561-2564.