阿替普酶治疗急性脑梗死疗效观察
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摘要
目的探讨阿替普酶治疗急性脑梗死(ACI)的临床效果。方法选择2015年3月至2018年3月长安医院收治的115例ACI患者为研究对象,按照治疗方法分为观察组(58例)和对照组(57例)。2组患者均给予补液、维持水电解质平衡、营养神经及调节血压、血脂、血糖等常规治疗,观察组患者在常规治疗基础上给予阿替普酶静脉溶栓治疗。治疗前及治疗后1、7 d,采用酶联免疫吸附试验检测患者血清中S100B、神经元特异性烯醇化酶(NSE)、丙二醛(MDA)、8-羟基脱氧鸟嘌呤(8-OHdG)水平,应用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评分;治疗前及治疗后7、15 d,应用Barthel指数进行日常生活能力评分。结果 2组患者治疗前血清NSE、S100B、MDA及8-OHdG水平比较差异无统计学意义(P> 0. 05),2组患者治疗后1、7 d血清NSE、S100B、MDA及8-OHdG水平显著低于治疗前(P <0. 05),2组患者治疗后7 d血清NSE、S100B、MDA及8-OHdG水平显著低于治疗后1 d(P <0. 05);治疗后1、7 d,观察组患者血清NSE、S100B、MDA及8-OHdG水平显著低于对照组(P <0. 05)。2组患者治疗前NIHSS评分比较差异无统计学意义(P> 0. 05),2组患者治疗后1、7 d NIHSS评分显著低于治疗前(P <0. 05),2组患者治疗后7 d NIHSS评分显著低于治疗后1 d(P <0. 05);治疗后1、7 d,观察组患者NIHSS评分显著低于对照组(P <0. 05)。2组患者治疗前日常生活能力评分比较差异无统计学意义(P> 0. 05),2组患者治疗后7、15 d日常生活能力评分显著高于治疗前(P <0. 05),2组患者治疗后15 d日常生活能力评分显著高于治疗后7 d(P <0. 05);治疗后7、15 d,观察组患者日常生活能力评分显著高于对照组(P <0. 05)。结论阿替普酶静脉溶栓治疗可以显著改善ACI患者神经功能,提高患者日常生活能力。
Objective To investigate the clinical effect of alteplase in the treatment of acute cerebral infarction( ACI).Methods A total of 115 patients with ACI admitted to Chang'an Hospital from March 2015 to March 2018 were selected as the study subjects,and the patients were divided into observation group( n = 58) and control group( n = 57) according to the treatment method. The patients in the two groups were given routine treatment such as fluid infusion,maintaining water and electrolyte balance,neurotrophic therapy and regulating blood pressure,blood lipid and blood sugar. The patients in the observation group were given intravenous thrombolysis with alteplase on the basis of routine treatment. The levels of serum S100 B,neuron specific enolase( NSE),malondialdehyde( MDA) and 8-hydroxydeoxyguanosine( 8-OHdG) were detected by enzyme-linked immunosorbent assay; and the neurologic impairment score was evaluated by the National Institutes of Health Stroke Scale( NIHSS) before and at one,seven days after treatment. The ability of daily living was evaluated by Barthel index before and at 7,15 days after treatment. Results There was no significant difference in the level of serum NSE,S100 B,MDA and 8-OHdG between the two groups before treatment( P > 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG at one and seven days after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG at seven days after treatment were significantly lower than those at one day after treatment in the two groups( P < 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG in the observation group were significantly lower than those in the control group at one and seven days after treatment( P < 0. 05). There was no significant difference in the NIHSS score between the two groups before treatment( P > 0. 05). The NIHSS score at one and seven days after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The NIHSS score at seven days after treatment was significantly lower than that at one day after treatment in the two groups( P < 0. 05). The NIHSS score in the observation group was significantly lower than that in the control group at one and seven days after treatment( P < 0. 05).There was no significant difference in the score of activity of daily living between the two groups before treatment( P > 0. 05).The score of ability of daily living was significantly higher at 7 and 15 days after treatment than that before treatment in the two groups( P < 0. 05). The score of ability of daily living at 15 days after treatment was significantly higher than that at 7 days after treatment in the two groups( P < 0. 05). The score of ability of daily living in the observation group was significantly higher than that in the control group at 7 and 15 days after treatment( P < 0. 05). Conclusion Alteplase intravenous thrombolysis can significantly improve the neurological function and ability of daily living of ACI patients.
Objective To investigate the clinical effect of alteplase in the treatment of acute cerebral infarction( ACI).Methods A total of 115 patients with ACI admitted to Chang'an Hospital from March 2015 to March 2018 were selected as the study subjects,and the patients were divided into observation group( n = 58) and control group( n = 57) according to the treatment method. The patients in the two groups were given routine treatment such as fluid infusion,maintaining water and electrolyte balance,neurotrophic therapy and regulating blood pressure,blood lipid and blood sugar. The patients in the observation group were given intravenous thrombolysis with alteplase on the basis of routine treatment. The levels of serum S100 B,neuron specific enolase( NSE),malondialdehyde( MDA) and 8-hydroxydeoxyguanosine( 8-OHdG) were detected by enzyme-linked immunosorbent assay; and the neurologic impairment score was evaluated by the National Institutes of Health Stroke Scale( NIHSS) before and at one,seven days after treatment. The ability of daily living was evaluated by Barthel index before and at 7,15 days after treatment. Results There was no significant difference in the level of serum NSE,S100 B,MDA and 8-OHdG between the two groups before treatment( P > 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG at one and seven days after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG at seven days after treatment were significantly lower than those at one day after treatment in the two groups( P < 0. 05). The levels of serum NSE,S100 B,MDA and 8-OHdG in the observation group were significantly lower than those in the control group at one and seven days after treatment( P < 0. 05). There was no significant difference in the NIHSS score between the two groups before treatment( P > 0. 05). The NIHSS score at one and seven days after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The NIHSS score at seven days after treatment was significantly lower than that at one day after treatment in the two groups( P < 0. 05). The NIHSS score in the observation group was significantly lower than that in the control group at one and seven days after treatment( P < 0. 05).There was no significant difference in the score of activity of daily living between the two groups before treatment( P > 0. 05).The score of ability of daily living was significantly higher at 7 and 15 days after treatment than that before treatment in the two groups( P < 0. 05). The score of ability of daily living at 15 days after treatment was significantly higher than that at 7 days after treatment in the two groups( P < 0. 05). The score of ability of daily living in the observation group was significantly higher than that in the control group at 7 and 15 days after treatment( P < 0. 05). Conclusion Alteplase intravenous thrombolysis can significantly improve the neurological function and ability of daily living of ACI patients.
引文
[1]江思德,唐明山,肖静,等.脑梗死急性期治疗临床研究进展[J].医学综述,2016,22(8):1513-1515.
[2]王允,代大伟,范宇威,等.急性脑梗死溶栓治疗的临床进展[J].现代生物医学进展,2017,17(26):5194-5196.
[3]陶晓薇,项国谦.急性脑梗死患者治疗前后血清Hcy和血浆TXB2、6-K-PGF1α检测的临床价值[J].检验医学,2017,32(1):69-70.
[4]尹丹卫,尚广芹.颈动脉狭窄或闭塞患者急性脑梗死发病机制的研究进展[J].中医临床研究,2017,9(15):21-24.
[5]钱惠东.直接经皮冠状动脉介入术后早期行再灌注治疗对急性心肌梗死患者的临床效果[J].医疗装备,2016,29(16):109-110.
[6]党庆莲,刘瑞.急诊介入手术治疗老年急性心肌梗死的近期疗效及其对患者血清炎症因子的影响[J].海南医学,2016,27(13):2085-2087.
[7]赵宏,汪立松,童巧文.阿替普酶静脉溶栓对急性脑梗死患者神经功能、炎症及氧化应激反应的影响[J].中华全科医学,2017,15(8):1345-1347.
[8]褚洪高,唐倩,赵洋.阿替普酶联合丁苯酞对急性脑梗死患者神经功能及血清应激因子的影响[J].解放军医药杂志,2017,29(6):103-106.
[9]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[10]陈连珍,陈明玉,敖春暖,等. GCS评分与NIHSS评分在脑梗死急诊溶栓后出血的预测价值[J].护理实践与研究,2016,13(1):17-19.
[11]陈秀玲,刘明. Barthel指数评定量表在临床康复患者中的应用[J].医药前沿,2016,6(16):100-101.
[12]李刚,吉萍,赵东刚,等.超早期溶栓治疗急性脑梗死的临床效果及安全性[J].中华老年多器官疾病杂志,2018,17(6):434-437.
[13]凌雪辉,周一心,詹青,等.阿替普酶对脑出血大鼠血脑屏障损伤的保护作用及机制[J].中国老年学杂志,2018,38(4):906-908.
[14]景东华,杨增烨,张正祥.血清神经元特异性烯醇化酶在缺血性脑卒中患者中的变化及意义[J].立体定向和功能性神经外科杂志,2014(2):83-86.
[15]杨飞云,孔令宇,杨亚勤,等.重组人促红细胞生成素治疗急性脑梗死疗效观察[J].新乡医学院学报,2017,34(10):912-915.
[2]王允,代大伟,范宇威,等.急性脑梗死溶栓治疗的临床进展[J].现代生物医学进展,2017,17(26):5194-5196.
[3]陶晓薇,项国谦.急性脑梗死患者治疗前后血清Hcy和血浆TXB2、6-K-PGF1α检测的临床价值[J].检验医学,2017,32(1):69-70.
[4]尹丹卫,尚广芹.颈动脉狭窄或闭塞患者急性脑梗死发病机制的研究进展[J].中医临床研究,2017,9(15):21-24.
[5]钱惠东.直接经皮冠状动脉介入术后早期行再灌注治疗对急性心肌梗死患者的临床效果[J].医疗装备,2016,29(16):109-110.
[6]党庆莲,刘瑞.急诊介入手术治疗老年急性心肌梗死的近期疗效及其对患者血清炎症因子的影响[J].海南医学,2016,27(13):2085-2087.
[7]赵宏,汪立松,童巧文.阿替普酶静脉溶栓对急性脑梗死患者神经功能、炎症及氧化应激反应的影响[J].中华全科医学,2017,15(8):1345-1347.
[8]褚洪高,唐倩,赵洋.阿替普酶联合丁苯酞对急性脑梗死患者神经功能及血清应激因子的影响[J].解放军医药杂志,2017,29(6):103-106.
[9]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[10]陈连珍,陈明玉,敖春暖,等. GCS评分与NIHSS评分在脑梗死急诊溶栓后出血的预测价值[J].护理实践与研究,2016,13(1):17-19.
[11]陈秀玲,刘明. Barthel指数评定量表在临床康复患者中的应用[J].医药前沿,2016,6(16):100-101.
[12]李刚,吉萍,赵东刚,等.超早期溶栓治疗急性脑梗死的临床效果及安全性[J].中华老年多器官疾病杂志,2018,17(6):434-437.
[13]凌雪辉,周一心,詹青,等.阿替普酶对脑出血大鼠血脑屏障损伤的保护作用及机制[J].中国老年学杂志,2018,38(4):906-908.
[14]景东华,杨增烨,张正祥.血清神经元特异性烯醇化酶在缺血性脑卒中患者中的变化及意义[J].立体定向和功能性神经外科杂志,2014(2):83-86.
[15]杨飞云,孔令宇,杨亚勤,等.重组人促红细胞生成素治疗急性脑梗死疗效观察[J].新乡医学院学报,2017,34(10):912-915.