[1]王继存,王剑新.神经介入辅助阿替普酶溶栓治疗急性缺血性脑卒中疗效观察[J].新乡医学院学报,2024,(1):032-36.[doi:10.7683/xxyxyxb.2024.01.006]
　WANG Jicun,WANG Jianxin.Therapeutic effect of neurointervention assisted alteplase thrombolysis in the treatment of acute ischemic stroke[J].Journal of Xinxiang Medical University,2024,(1):032-36.[doi:10.7683/xxyxyxb.2024.01.006]
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神经介入辅助阿替普酶溶栓治疗急性缺血性脑卒中疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年1
页码:
032-36
栏目:
临床研究
出版日期:
2024-01-05

文章信息/Info

Title:
Therapeutic effect of neurointervention assisted alteplase thrombolysis in the treatment of acute ischemic stroke
作者:
王继存1; 王剑新2
(1.北京市顺义区医院神经疾病中心一病区，北京　101312；2.河南省人民医院/河南省脑血管病医院/郑州大学人民医院/河南大学人民医院神经外科，河南　郑州　463599)
Author(s):
WANG Jicun1; WANG Jianxin2
(1.Neurological Disease Center,Beijing Shunyi Hospital,Beijing 101312，China;2.Department of Neurosurgery,Henan Provincial People′s Hospital/Henan Provincial Cerebrovascular Disease Hospital/Zhengzhou University People′s Hospital/Henan University People′s Hospital,Zhengzhou 463599,Henan Province,China)
关键词:
急性缺血性脑卒中; 神经介入; 阿替普酶; 神经因子
Keywords:
acute ischemic stroke; nerurointervention; alteplase; neurolin
分类号:
R743.3
DOI:
10.7683/xxyxyxb.2024.01.006
文献标志码:
A
摘要:
目的　探讨神经介入辅助阿替普酶溶栓治疗急性缺血性脑卒中（AIS）的临床疗效。
方法　选择2022年6月至2023年6月北京市顺义区医院收治的104例AIS患者为研究对象。依据治疗方法将患者分为观察组和对照组，每组52例。对照组患者给予阿替普酶溶栓治疗，观察组患者给予神经介入辅助阿替普酶溶栓治疗。治疗后2周根据美国国立卫生研究院卒中量表（NIHSS）评分评估2组患者的治疗效果。治疗前和治疗后3、7 d，采用酶联免疫吸附法检测2组患者血清神经生长因子（NGF）、神经元特异性烯醇化酶（NSE）及中枢神经特异蛋白S100β水平；采用超声经颅多普勒血液分析仪检测2组患者颈总动脉、基底动脉、椎动脉收缩期峰流速；采用NIHSS评分评估2组患者的神经功能损伤程度。记录2组患者治疗期间药物相关不良反应发生情况。治疗后3个月采用改良Rankin评分评估2组患者综合生活能力。
结果　对照组和观察组患者的治疗总有效率分别为80.77%（42/52）、96.15%（50/52），观察组患者治疗总有效率显著高于对照组（χ2=6.029,P<0.05）。治疗前2组患者血清NGF、NSE、S100β水平比较差异无统计学意义（P>0.05）。2组患者治疗后3、7 d血清NGF水平显著高于治疗前，NSE、S100β水平显著低于治疗前（P<0.05）。治疗后3、7 d，观察组患者血清NGF水平显著高于对照组，NSE、S100β水平显著低于对照组（P<0.05）。治疗前2组患者颈总动脉、基底动脉、椎动脉收缩期峰流速比较差异无统计学意义（P>0.05）。2组患者治疗后3、7 d颈总动脉、基底动脉、椎动脉收缩期峰流速显著低于治疗前（P<0.05）。治疗后3、7 d，观察组患者颈总动脉、基底动脉、椎动脉收缩期峰流速显著低于对照组（P<0.05）。治疗前2组患者NIHSS评分比较差异无统计学意义（P>0.05）。2组患者治疗后3、7 d NIHSS评分显著低于治疗前（P<0.05）。治疗后3、7 d，观察组患者NIHSS评分显著低于对照组（P<0.05）。对照组和观察组患者治疗期间总不良反应发生率分别为7.69%（4/52）、9.62%（5/52），2组患者治疗期间总不良反应发生率比较差异无统计学意义（χ2=0.000，P>0.05）。治疗后3个月，观察组患者综合生活能力优于对照组（P<0.05）。
结论　神经介入辅助阿替普酶溶栓治疗能显著提高AIS患者的治疗效果，改善神经因子表达，减轻神经功能损伤程度，提高患者综合生活能力，且具有一定安全性。
Abstract:
Objective　To explore the clinical effect of neurointervention assisted alteplase thrombolysis in the treatment of acute ischemic stroke (AIS).
Methods　A total of 104 AIS patients admitted to Beijing Shunyi Hospital from June 2022 to June 2023 were selected as the research subjects,and they were divided into observation group and control group according to the treatment method,with 52 cases in each group.The patients in the control group were treated with alteplase thrombolysis,and the patients in the observation group were treated with neurointervention assisted alteplase thrombolysis.The therapeutic effect of patients in the two groups was evaluated according to the National Institutes of Health stroke scale (NIHSS) score at two weeks after treatment.Before treatment and 3,7 days after treatment,the serum nerve growth factor（NGF）,neuron specific enolase(NSE）,central nervous system specific protein S100β levels of patients in the two groups were detected by enzyme-linked immunosorbent assay;the peak systolic velocities of common carotid artery,basilar artery and vertebral artery of patients in the two groups were detected by ultrasound transcranial Doppler blood analyzer;the degree of neurological damage of patients in the two groups was evaluated by NIHSS scores.The occurrence of drug-related adverse reactions during treatment of patients in the two groups were recorded;the comprehensive living ability of patients in the two groups was evaluated by improved Rankin score at three months after treatment.
Results　The total effective rates of patients in the control group and the observation group were 80.77% (42/52) and 96.15% (50/52),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group (χ2=6.029,P<0.05).There was no significant difference in the serum NGF,NSE,S100β levels of patients between the two groups before treatment(P>0.05).Compared with before treatment,the serum NGF level of patients in the two groups increased,and the serum NSE,S100β levels decreased at 3,7 days after treatment(P<0.05).At 3,7 days after treatment,the serum NGF level of patients in the observation group was significantly higher than that in the control group,and the serum NSE,S100β levels were significantly lower than those in the control group(P<0.05).There was no significant difference in the peak systolic velocities of common carotid artery,basilar artery and vertebral artery of patients between the two groups before treatment (P>0.05).The peak systolic velocities of common carotid artery,basilar artery and vertebral artery of patients at 3,7 days after treatment were significantly lower than those before treatment in the two groups (P<0.05).After 3,7 days after treatment,the peak systolic velocities of common artery,basilar artery,and vertebral artery of patients in the observation group were significantly lower than those in the control group (P<0.05).There was no significant difference in NIHSS score of patients between the two groups before treatment (P>0.05).The NIHSS score of patients at 3,7 days after treatment was significantly lower than that before treatment in the two groups (P<0.05).At 3,7 days after treatment,the NIHSS score of patients in the observation group was significantly lower than that in the control group (P<0.05).The total incidence of adverse reactions of patients during treatment in the control group and observation group was 7.69% (4/52) and 9.62% (5/52),respectively;there was no significant difference in the total incidence of adverse reactions during treatment of patients between the two groups（χ2=0.000，P>0.05).At 3 months after treatment,the comprehensive living ability of patients in the observation group was better than that in the control group (P<0.05).
Conclusion　Neurointervention assisted with alteplase thrombolysis in the treatment of AIS patients can significantly improve the treatment efficacy and the expression of neurolin,reduce the degree of neurological impairment and improve comprehensive living ability,and has a certain degree of safety.

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更新日期/Last Update: 2024-01-05