摘要
目的:探讨静脉溶栓联合支架介入取栓治疗缺血性脑卒中(IS)的临床效果。方法:选取2020年7月~2023年6月期间某院收治的94例IS患者作为研究对象,采用随机数字表法分为对照组和联合组,每组47例。两组患者均给予吸氧、抗感染、降低颅内压、保护脑神经等常规治疗,对照组患者在常规治疗基础上给予支架介入取栓治疗,联合组患者在对照组治疗基础上给予静脉溶栓治疗。比较两组患者阻塞血管再通情况、血管生长相关因子[血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)]、神经损伤因子[中枢神经特异性蛋白β(S100β)、谷氨酸、血小板源性生长因子(PDGF)]、脑血管储备功能指标[大脑中动脉搏动指数(MCA-PI)、大脑中动脉血流速度、脑血管储备功能(CVRC)]、生活质量[巴塞尔指数(BI)]、神经功能[美国国立卫生研究院卒中量表(NIHSS)]、生存质量[改良Rankin量表(mRS)]及不良反应发生情况。结果:治疗后,联合组患者阻塞血管再通率(91.49%)高于对照组(72.34%,P<0.05)。两组患者血清VEGF、MMP-9水平均降低(P<0.05),且联合组低于对照组(P<0.05);血清S100β、谷氨酸、PDGF水平均降低(P<0.05),且联合组低于对照组(P<0.05);大脑中动脉血流速度、CVRC均升高(P<0.05),且联合组高于对照组(P<0.05);MCA-PI均降低(P<0.05),且联合组低于对照组(P<0.05);BI评分均升高(P<0.05),且联合组高于对照组(P<0.05);NIHSS、mRS评分均降低(P<0.05),且联合组低于对照组(P<0.05)。两组患者均未发生严重不良反应。结论:静脉溶栓联合支架介入取栓治疗可有效提高IS患者阻塞血管再通率,降低血管生长相关因子、神经损伤因子水平,增强患者脑血管储备功能,改善患者神经功能及生活质量,提高生存质量,且安全性较高。
Objective:To investigate the clinical efficacy of intravenous thrombolysis combined with stent interventional thrombectomy in the treatment of ischemic stroke(IS).Methods:A total of 94 IS patients treated in a hospital from July 2020 to June 2023 were selected and assigned to the control group and combination group by random number table method,with 47 patients in each group.Conventional treatment was provided in both groups,including oxygen inhalation,anti-infection,reducing intracranial pressure,protecting cerebral nerves,etc.Patients in the control group additionally underwent stent interventional thrombectomy,and those in the combination group additionally underwent intravenous thrombolysis with the treatment given in the control group.The vascular recanalization,vascular growth related factors[vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)],nerve injury factors[central nervous system specific proteinβ(S100β),glutamate and platelet-derived growth factor(PDGF)],cerebrovascular reserve function indicators[middle cerebral artery pulsatility index(MCA-PI),middle cerebral artery flow velocity,cerebrovascular reserve capacity(CVRC)],quality of life[Barthel index(BI)],neurological function[National Institutes of Health Stroke Scale(NIHSS)],quality of living[modified Rankin scale(mRS)]and adverse reactions were compared between the two groups.Results:After treatment,the recanalization rate in the combination group(91.49%)was higher than that in the control group(72.34%,P<0.05).The serum levels of VEGF and MMP-9 in both groups were significantly decreased(P<0.05),and were lower in the combination group as compared with the control group(P<0.05).The serum levels of S100β,glutamate and PDGF in both groups were decreased(P<0.05),and were lower in the combination group as compared with the control group(P<0.05).The levels of middle cerebral artery flow velocity and CVRC were increased in both groups(P<0.05),and were higher in the combination group as compared with the control group(P<0.05).The MCA-PI in both groups was decreased(P<0.05),and was lower in the combination group as compared with the control group(P<0.05).The BI score in both groups was increased(P<0.05),and was higher in the combination group as compared with the control group(P<0.05).The scores of NIHSS and mRS in both groups were decreased(P<0.05),and were lower in the combination group as compared with the control group(P<0.05).No serious adverse reactions occurred in either group.Conclusion:Intravenous thrombolysis combined with stent interventional thrombectomy in the treatment of IS can effectively improve the recanalization rate,reduce the levels of vascular growth related factors and nerve injury factors,enhance the cerebrovascular reserve capacity,improve the neurological function and quality of life,and improve the quality of living,with a high safety profile.
作者
孙世辉
彭兆龙
吴广
SUN Shi-hui;PENG Zhao-long;WU Guang(Stroke Ward Ⅱ,Nanshi Hospital of Nanyang,Nanyang 473000,China)
出处
《中国合理用药探索》
CAS
2024年第5期5-11,共7页
Chinese Journal of Rational Drug Use
基金
河南省医学科技攻关计划项目(LHGJ202003125)。
关键词
支架介入取栓
静脉溶栓
缺血性脑卒中
血管生长相关因子
神经损伤因子
脑血管储备功能
stent interventional thrombectomy
intravenous thrombolysis
ischemic stroke
vascular growth related factors
nerve injury factors
cerebrovascular reserve capacity
