摘要
目的探讨阿替普酶(alteplase,rt-PA)静脉溶栓联合依达拉奉在低美国国立卫生研究院脑卒中评分(national institutes of health stroke score,NIHSS)急性缺血性脑卒中(acute ischemic stroke,AIS)患者中的应用价值。方法回顾性分析安庆市立医院2023年1月至2024年2月收治的86例低NIHSS评分(≤5分)AIS患者的临床资料,常规治疗联合rt-PA静脉溶栓为对照组,rt-PA静脉溶栓联合依达拉奉治疗为研究组,对比两组临床疗效、神经损伤标志物[人脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)]、血液流变学指标、出血并发症、预后。结果研究组、对照组总有效率分别为93.02%、74.42%,对比差异有统计学意义(χ^(2)=4.181,P<0.05);治疗后研究组、对照组BDNF[分别为(4.48±0.58)μg·L^(-1)、(3.85±0.32)μg·L^(-1)]高于治疗前[分别为(3.15±0.22)μg·L^(-1)、(3.09±0.25)μg·L^(-1)],且研究组高于对照组,差异有统计学意义(t=6.237,P<0.05);治疗后研究组、对照组NSE[分别为(5.26±1.02)μg·L^(-1)、(9.36±1.22)μg·L^(-1)]低于治疗前[分别为(17.86±2.15)μg·L^(-1)、(18.05±2.26)μg·L^(-1)],且研究组低于对照组,差异有统计学意义(t=16.907,P<0.05);治疗后研究组、对照组全血低切黏度、全血中切黏度、全血高切黏度[分别为(7.25±1.23)mPa·s、(6.38±0.78)mPa·s、(5.67±0.59)mPa·s,(9.56±1.38)mPa·s、(7.39±0.82)mPa·s、(6.71±0.62)mPa·s]均低于治疗前[分别为(11.54±1.58)mPa·s、(8.58±1.31)mPa·s、(7.28±0.85)mPa·s,(11.75±1.62)mPa·s、(8.45±1.26)mPa·s、(7.25±0.92)mPa·s],且研究组低于对照组,差异有统计学意义(t=8.194、5.852、7.968,均P<0.05);研究组、对照组并发症发生率分别为4.65%、9.30%,差异有统计学意义(χ^(2)=5.800,P<0.05);随访90 d研究组改良Rankin量表评分[(2.28±0.21)分]低于对照组[(3.01±0.45)分],预后良好者占比(86.05%)高于对照组(65.12%),差异有统计学意义(t=9.640,χ^(2)=5.103,均P<0.05)。结论通过rt-PA静脉溶栓联合依达拉奉治疗AIS能够获得良好的疗效,有助于改善神经损伤水平及血液流变学指标,具有良好的安全性及预后。
Objective To explore the application value of rt-PA intravenous thrombolysis combined with edaravone in patients with acute ischemic stroke(AIS)of low National Institutes of Health Stroke Scale(NIHSS)score.Methods A retrospective analysis was conducted on the clinical data of 86 patients with AIS and low NIHSS score(≤5 points)admitted to Anqing Municipal Hospital from January 2023 to February 2024.The patients in the control group received conventional treatment combined with rt-PA intravenous thrombolysis,while those in the study group received rt-PA intravenous thrombolysis combined with edaravone treatment.The two groups were compared in clinical efficacy,neural injury markers(brain-derived neurotrophic factor(BDNF),neuron-specific enolase(NSE)),hemorheological indicators,bleeding complications,and the prognosis.Results The total effective rate was 93.02%in the study group and 74.42%in the control group,with a statistically significant difference(χ^(2)=4.181,P<0.05).Post-treatment BDNF levels of the study group and the control group((4.48±0.58)μg·L^(-1),(3.85±0.32)μg·L^(-1))were higher than pre-treatment levels((3.15±0.22)μg·L^(-1),(3.09±0.25)μg·L^(-1)),and these indicators were higher in the former group,with a statistically significant difference(t=6.237,P<0.05).Post-treatment NSE levels of the study group and the control group((5.26±1.02)μg·L^(-1),(9.36±1.22)μg·L^(-1))were lower than pre-treatment levels((17.86±2.15)μg·L^(-1),(18.05±2.26)μg·L^(-1)),and these indicators were lower in the former group,with a statistically significant difference(t=16.907,P<0.05).Post-treatment whole blood low shear viscosity,whole blood medium shear viscosity and whole blood high shear viscosity in the study group and the control group((7.25±1.23)mPa·s,(6.38±0.78)mPa·s,(5.67±0.59)mPa·s,(9.56±1.38)mPa·s,(7.39±0.82)mPa·s,(6.71±0.62)mPa·s)were lower than pre-treatment values((11.54±1.58)mPa·s,(8.58±1.31)mPa·s,(7.28±0.85)mPa·s,(11.75±1.62)mPa·s,(8.45±1.26)mPa·s,(7.25±0.92)mPa·s),and these indices were lower in the former group,with statistically significant differences(t=8.194,5.852,7.968,all P<0.05).The complication rate was 4.65%in the study group and 9.30%in the control group,with a statistically significant difference(χ^(2)=5.800,P<0.05).After 90 days of follow-up,mRS scores of the study group and the control group were(2.28±0.21)points and(3.01±0.45)points,and the former was lower;the proportions of patients with good prognosis were 86.05%and 65.12%,and the former was higher,with statistically significant differences(t=9.640,χ^(2)=5.103,both P<0.05).Conclusion The combination of rt-PA intravenous thrombolysis and edaravone can achieve good therapeutic effects on AIS since it can improve the levels of neural injury and hemorheological indicators,and has good safety and prognosis.
作者
施彦杰
施雪英
唐向阳
曹莉
李博
Shi Yanjie;Shi Xueying;Tang Xiangyang;Cao Li;Li Bo(Department of Neurology,Anqing Municipal Hospital,Anqing 246000,China)
出处
《中国药物应用与监测》
2025年第5期770-773,共4页
Chinese Journal of Drug Application and Monitoring
基金
安徽省高等学校科学研究项目(2023AH040410)。
