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Received:July 07, 2020 Published Online:April 20, 2021
Received:July 07, 2020 Published Online:April 20, 2021
中文摘要: 目的 探讨阿替普酶静脉溶栓联合丁苯酞对急性脑梗死患者的疗效、安全性以及对患者血清氧化应激水平的影响。方法 选择2016年1月至2019年12月在北京航天总医院急诊或神经内科明确诊断为急性脑梗死的患者共120例,随机分为对照组60例与观察组60例。对照组采取阿替普酶溶栓治疗,观察组给予阿替普酶溶栓联合丁苯酞治疗;比较两组神经功能缺损(NIHSS)评分、日常生活能力(Barthel指数)、改良Rankin量表(mRS)评分,观察急性脑梗死溶栓效果,评价两组临床疗效和症状性颅内出血(SICH)发生率,并比较两组治疗前后血清氧化应激指标［谷胱甘肽过氧化物酶(GSH-Px)和活性氧(ROS)］水平。结果 (1)两组治疗后NIHSS指数均呈逐渐下降趋势,Barthel指数均呈逐渐升高趋势(P<0.01,P<0.05),但组间比较差异均无统计学意义(P>0.05)。两组早期静脉溶栓治疗有效率、生活质量满意度比较差异无统计学意义(P>0.05)。(2)两组治疗14 d时的mRS评分均低于治疗7 d(P<0.01),但组间比较差异无统计学意义(P>0.05);治疗14 d后两组神经功能转归良好率比较差异无统计学意义(P>0.05)。(3)两组静脉溶栓后血管再通情况、治疗总有效率、并发症发生率比较差异无统计学意义(P>0.05)。(4)治疗后,两组GSH-Px水平高于治疗前,ROS水平低于治疗前(P<0.05);且观察组GSH-Px水平高于对照组,ROS水平低于对照组(P<0.05)。结论 阿替普酶静脉溶栓联合丁苯酞治疗急性脑梗死(发病4.5 h内)可取得良好疗效,能更好地改善患者血清氧化应激水平,与单用阿替普酶静脉溶栓的安全性相当。
Abstract:Objective To investigate the efficacy and safety of intravenous thrombolysis with alteplase combined with buphthalein in patients with acute cerebral infarction(ACI) and the effect on the serum oxidative stress level.
Methods A total of 120 patients with ACI in the Emergency Department or Neurology Department of Beijing Aerospace General Hospital from January 2016 to December 2019 were selected and divieded into control group and observation group randomly (n=60,each).The control group was treated with alteplase thrombolysis,while the observation group was treated with alteplase thrombolysis combined with buphthalein.The neurological deficit (NIHSS),activities of daily living (Barthel Index),modified Rankin Scale (mRS) of the two groups were compared,the thrombolytic effect in ACI was observed,the clinical efficacy and symptomatic intracranial hemorrhage (SICH) incidence of the two groups were evaluated and the serum oxidative stress indicators［glutathione peroxidase (GSH-Px) and reactive oxygen species (ROS)］levels before and after treatment between the two groups were compared.
Results NIHSS tended to decrease gradually after treatment in both groups,while Barthel Indexes tended to increase gradually (P<0.05),but the difference between the two groups was not significant(P>0.05).The MRS scores at 14 d of treatment were lower in both groups than at 7 d of treatment (P<0.01),but the difference between the two groups was not significant(P>0.05).There was no significant difference in the rate of good neurological outcome between the two groups after 14 d of treatment (P>0.05).
After intravenous thrombolysis,there was no significant difference between the two groups in vascular recanalization,the total effective rate of treatment,and the incidence of complications
(P>0.05).After treatment,GSH-Px levels were higher and ROS levels were lower than those before treatment in both groups (P<0.05),and GSH-Px levels were higher and ROS levels were lower in the observation group than those in the control group (P<0.05).
Conclusion Intravenous thrombolysis with alteplase combined with buphthalein in the treatment of ACI(within 4.5 h) can achieve good outcomes and can improve the patients′ serum oxidative stress level,which is comparable to the safety of intravenous thrombolysis with alteplase alone.
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