摘要
目的探讨静脉溶栓联合动脉取栓治疗急性缺血性脑卒中的疗效及安全性。方法选择2015年1月至2018年3月驻马店市中心医院收治的80例急性缺血性脑卒中患者作为研究对象,采用随机数字表法将患者分为对照组和观察组,每组40例。2组患者均给予重组组织型纤溶酶原激活剂(0.9mg·kg^-1,总剂量控制在90mg以内)进行静脉溶栓治疗;在此基础上,观察组患者给予动脉血管内支架取栓治疗。比较2组患者治疗后血管再通率、临床疗效及预后;分别于治疗前后采用美国国立卫生研究院卒中量表(NIHSS)评估2组患者的神经功能损伤程度,采用Barthel指数评估2组患者的日常生活能力,采用生活质量综合评定量表评估2组患者的生活质量。采用酶联免疫吸附试验检测2组患者血清炎症因子水平。结果观察组和对照组患者血管再通率分别为77.50%(31/40)、35.00%(14/40),总有效率分别为95.00%(38/40)、75.00%(30/40),观察组患者血管再通率和总有效率均显著高于对照组(χ^2=14.679、6.275,P<0.05)。治疗前2组患者NIHSS评分及Barthel指数比较差异无统计学意义(P>0.05);2组患者治疗后NIHSS评分低于治疗前,Barthel指数高于治疗前(P<0.05);治疗后,观察组患者NIHSS评分低于对照组,Barthel指数高于对照组(P<0.05)。治疗前2组患者的血清C反应蛋白(CRP)、白细胞介素-6(IL-6)及降钙素原(PCT)水平比较差异无统计学意义(P>0.05);治疗后2组患者血清CRP、IL-6及PCT水平低于治疗前(P<0.05);治疗后,观察组患者血清CRP、IL-6及PCT水平均低于对照组(P<0.05)。观察组和对照组患者症状性颅内出血率分别为7.50%(3/40)、5.00%(2/40),2组患者症状性颅内出血率比较差异无统计学意义(χ^2=0.213,P>0.05)。观察组患者中预后良好病例数多于对照组(χ^2=4.053,P<0.05);轻度残疾率、重度残疾率、植物生存率、病死率与对照组比较差异无统计学意义(χ^2=0.220、2.222、2.051、1.013,P>0.05)。治疗前2组患者躯体功能、心理健康、社会关系、生活环境得分比较差异均无统计学意义(P>0.05);2组患者治疗后躯体功能、心理健康、社会关系、生活环境得分均高于治疗前(P<0.05);治疗后,观察组患者躯体功能、心理健康、社会关系、生活环境得分均高于对照组(P<0.05)。结论静脉溶栓联合动脉取栓治疗急性缺血性脑卒中可有效促使血管再通,改善患者神经功能、日常生活能力和生活质量。
Objective To investigate the effect and safety of intravenous thrombolysis combined with arterial thrombectomy in the treatment of acute ischemic stroke.Methods Eighty patients with acute ischemic stroke admitted to Zhumadian Central Hospital from January 2015 to March 2018 were selected as the study subjects.The patients were divided into control group and observation group by random number table method,with 40 cases in each group.All patients were given intravenous thrombolysis with recombinant tissue plasminogen activator(0.9 mg·kg^-1,the total dose controlled within 90 mg).Based on this,the patients in the observation group were given intravascular stent thrombolysis.Vascular recanalization rate,clinical efficacy and prognosis were compared between the two groups after treatment.Neurological impairment was assessed by National Institutes of Health Stroke Scale(NIHSS)before and after treatment;the daily living ability was assessed by Barthel index;and the quality of life was assessed by comprehensive assessment scale.The levels of serum inflammatory factors were detected by enzyme linked immunosorbent assay in the two groups.Results The vessel recanulation rate of patients in the observation group and control group was 77.50%(31/40),35.00%(14/40),and the total effective rate was 95.00%(38/40)and 75.00%(30/40),respectively.The vessel recanulation rate and total effective rate of patients in the observation group were significantly higher than those in the control group(χ^2=14.679,6.275;P<0.05).There was no significant difference in the NIHSS score and Barthel index between the two groups before treatment(P>0.05).After treatment,the NIHSS score was lower than that before treatment,and the Barthel index was higher than that before treatment(P<0.05).After treatment,the NIHSS score of patients in the observation group was lower than that in the control group,and the Barthel index was higher than that in the control group(P<0.05).There was no significant difference in the serum levels of C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)between the two groups before treatment(P>0.05).The serum levels of CRP,IL-6 and PCT of patients after treatment were lower than those before treatment in the two groups(P<0.05).After treatment,the serum levels of CRP,IL-6 and PCT of patients in the observation group were lower than those in the control group(P<0.05).The rates of symptomatic intracranial hemorrhage of patients in the observation group and control group were 7.50%(3/40)and 5.00%(2/40),respectively;there was no statistic difference in the rates of symptomatic intracranial hemorrhage between the two groups(χ^2=0.213,P>0.05).The number of patients with better prognosis in the observation group was higher than that in the control group(χ^2=4.053,P<0.05);there were no statistic differences in the rates of mild disability,severe disability,plant survival and mortality between the two groups(χ^2=0.220,2.222,2.051,1.013;P>0.05).There was no statistic difference in the scores of physical function,mental health,social relations and living environment between the two groups before treatment(P>0.05).The scores of physical function,mental health,social relationship and living environment of patients after treatment were higher than those before treatment in the two groups(P<0.05).After treatment,the scores of physical function,mental health,social relationship and living environment of patients in the observation group were higher than those in the control group(P<0.05).Conclusion Intravenous thrombolysis combined with arterial thrombectomy in the treatment of acute ischemic stroke can effectively promote blood vessel recanalization,improve neurological function,daily living ability and quality of life of patients.
作者
王玉东
WANG Yu-dong(Department of Emergency,Zhumadian Central Hospital,Zhumadian 463000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2019年第8期764-767,共4页
Journal of Xinxiang Medical University
关键词
急性缺血性脑卒中
静脉溶栓
动脉取栓
血管再通
acute ischemic stroke
intravenous thrombolysis
arterial thrombolysis
vascular recanalization
作者简介
王玉东(1974-),男,河南确山人,硕士,副主任医师,研究方向:急诊医学。
