摘要
目的分析数字减影血管造影(DSA)引导下神经介入取栓术联合替罗非班治疗急性脑梗死患者的效果及对血管活性因子的影响。方法以2020-01—2023-01宣城市中心医院治疗的66例明确诊断为急性脑梗死且发病4.5 h内行阿替普酶静脉溶栓术后患者为对象,采取随机数字表法分为对照组33例和观察组33例。对照组患者采用DSA引导下神经介入取栓术治疗,观察组患者采用替罗非班联合DSA引导下神经介入取栓术治疗。比较2组患者治疗前后的脑动脉平均流速(MV)、搏动指数(PI)、阻力指数(RI)、颈动脉内膜中层厚度(C-IMT),颈动脉斑块(Crouse)积分、血管内皮细胞生长因子(VEGF)、基质金属蛋白酶9(MMP-9)、血管紧张素Ⅱ(AngⅡ)。结果观察组较对照组治疗总有效率更高(96.97%比75.76%,χ^(2)=6.339,P<0.05)。治疗后观察组Vm高于对照组[(19.53±0.65)cm/s比(18.97±0.78)cm/s],PI、RI低于对照组[(14.39±4.67)kPa·s·m^(-1)比(21.43±6.58)kPa·s·m^(-1),(50.53±5.92)kPa·s·m^(-1)比(58.72±7.89)kPa·s·m^(-1)](分别为t=3.168、5.012、4.770,P<0.05)。治疗后观察组C-IMT、Crouse积分低于对照组[(1.28±0.13)mm比(1.37±0.15)mm,(3.09±0.43)分比(3.58±0.51)分](分别为t=2.605、4.220,P<0.05)。治疗后观察组VEGF高于对照组[(478.62±39.43)ng/L比(425.84±43.92)ng/L],MMP-9、AngⅡ低于对照组[(129.57±23.76)μg/L比(153.46±25.98)μg/L,(51.62±10.63)ng/L比(59.72±12.38)ng/L](分别为t=5.137、3.898、2.852,P<0.05)。结论DSA引导下神经介入取栓术联合替罗非班治疗急性脑梗死有助于提高效果,促进患者脑血流动力学指标改善,降低C-IMT、Crouse积分,调节血管活性因子。
Objective To analyze the effect of neurointerventional thrombectomy guided by digital subtraction angiography(DSA)combined with tirofiban in the treatment of acute cerebral infarction and its effect on vascular active factors.Methods Sixty-six patients treated in Xuancheng Central Hospital between January 2020 and January 2023 were clearly diagnosed with acute cerebral infarction and underwent alteplase intravenous thrombolysis within 4.5 hours of onset,and were divided into the control group(n=33)(and the observation group n=33).The control group was treated by DSA-guided nerve interventional thrombolysis,group was treated by tirofiban combined with DSA while the observation-guided neurointerventional thrombolysis.Mean velocity(MV),pulsatility index(PI),resistance index(RI),carotid artery intima-media thickness(C-IMT),Crouse score,vascular endothelial growth factor(VEGF),matrix metalloproteinase 9(MMP-9),angiotensinⅡ(AngⅡ)were compared between the two groups before and after treatment.Results The total effective rate of observation group was higher than that of control group(96.97%vs 75.76%,χ^(2)=6.339,P<0.05).After treatment,Vm in observation group was higher than control group[(19.53±0.65)cm/s vs(18.97±0.78)cm/s],lower than control group[(14 PI and RI were.39±4.67)kPa·s·m^(-1) vs(21.43±6.58)kPa·s·m^(-1),(50.53±5.92)kPa·s·m^(-1) vs(58.72±7.89)kPa·s·m^(-1)](t=3.168,5.012,4.770,respectively,P<0.05).After treatment,the C-IMT and Crouse scores in the observation group were lower than those in the control group[(1.28±0.13)mm vs(1.37±0.15)mm,(3.09±0.43)points vs(3.58±0.51)points](t=2.605,4.220,respectively,P<0.05).After treatment,VEGF in observation group was higher than that in control group[(478.62±39.43)ng/L vs(425.84±43.92)ng/L],MMP-9 and AngⅡwere lower than those in control group[(129.57±23.76)μg/L vs(153.46±25.98)μg/L(51.62,±10.63)ng/L vs(59.72±12.38)ng/L](t=5.137,3.898,2.852,respectively,P<0.05).Conclusion DSA-guided neurointerventional thrombectomy combined with tirofiban in the treatment of acute cerebral infarction can improve the therapeutic effect,promote the improvement of cerebral hemodynamic indexes,reduce C-IMT and Crouse scores,and regulate vascular active factors.
作者
吕祖艳
曹敦宇
昝宏翔
LYU Zuyan;CAO Dunyu;ZAN Hongxiang(Xuancheng Central Hospital,Xuancheng 242000,China)
出处
《中国实用神经疾病杂志》
2024年第9期1117-1121,共5页
Chinese Journal of Practical Nervous Diseases
基金
2022年度宣城市卫生健康科研项目(编号:XCWJ2022028)。
关键词
急性脑梗死
神经介入取栓术
数字减影血管造影
替罗非班
阿替普酶
静脉溶栓
血管活性因子
Acute cerebral infarction
Interventional embolectomy
Digital subtraction angiography
Tirofiban
Alteplase
Intravenous thrombolysis
Vascular active factors
