不同时间窗阿替普酶在脑梗死患者中的疗效及对认知功能的影响
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摘要
目的分析不同时间窗阿替普酶在脑梗死患者中的疗效及对认知功能的影响。方法选择2016年1月—2018年4月我院诊治的95例脑梗死患者,按照患者接受阿替普酶静脉溶栓时间分为2组,观察组为发病距离溶栓时间<3 h的患者45例,对照组为发病距离溶栓时间在3～4.5 h的患者50例。分析2组患者的治疗效果、神经功能恢复、认知功能以及脑出血情况。结果治疗后7 d,2组总有效率差异无统计学意义(88.9%vs. 82.0%,P>0.05);2组患者经阿替普酶治疗后1 d与7 d的NIHSS评分、MESSS评分均低于治疗前(均P<0.05);同时观察组在治疗后1 d与7 d的NIHSS评分[(7.13±2.42)分、(4.85±1.76)分]、MESSS评分[(8.48±2.72)分、(5.61±2.05)分]均低于对照组[(8.48±2.86)分、(6.08±2.31)分;(10.08±3.09)分、(7.23±2.81)分](均P<0.05);治疗后7 d,观察组的MRS评分等级[预后良好(91.11%)、预后不良(8.89%)、死亡(0)]明显优于对照组[预后良好(76.00%)、预后不良(20.00%)、死亡(4.00%)](P<0.05);治疗后7 d,观察组出现脑出血发生率为2.22%,低于对照组的14.00%(P<0.05)。结论脑梗死患者在发病距离溶栓时间<3 h采用阿替普酶静脉溶栓治疗可明显改善患者的神经功能以及认知功能,降低脑出血发生率。
Objective To compare the effects of different time windows of alteplase on cognitive function in patients with cerebral infarction.Methods Ninety-five patients with cerebral infarction who were treated in our hospital from January 2016 to April 2018 were divided into two groups according to the time of intravenous thrombolytic therapy with alteplase. The observation group included patients with thrombolytic time <3 h, and the control group consisted of 50 patients with 3 to 4.5 h from onset to thrombolysis. The therapeutic effects, neurological recovery, cognitive function and cerebral hemorrhage were analyzed in the two groups.Results After 7-day treatment, there was no significant difference in the total effective rate between the two groups(88.9% vs. 82.0%, P>0.05). The NIHSS score and MESSS score were significantly higher after one-day and seven-day treatment with alteplase than those before treatment in two groups(all P<0.05). At the same time, the NIHSS scores and MESSS scores were significantly lower after one-day and seven-day treatment in the observation group[(7.13±2.42) points,(4.85±1.76) points for NIHSS and(8.48±2.72) points,(5.61±2.05) points for MESSS]than those of control group [(8.48±2.86) points,(6.08±2.31) points for NIHSS and(10.08±3.09) points,(7.23±2.81) points for MESSS, P<0.05]. After 7-day treatment, the MRS scores were significantly better in the observation group(good prognosis91.11%, poor prognosis 8.89% and no death) than those of the control group[good prognosis 76.00%, poor prognosis 20.00%and death 4.00%, P<0.05]. After 7-day treatment, the incidence rate of cerebral hemorrhage was 2.22% in the observation group, which was significantly lower than that of the control group(14.00%, χ~2=4.260, P<0.05).Conclusion Arteplase intravenous thrombolytic therapy(<3 h from onset to thrombolysis) can significantly improve the neurological and cognitive functions in patients with cerebral infarction and reduce the incidence of cerebral hemorrhage.
Objective To compare the effects of different time windows of alteplase on cognitive function in patients with cerebral infarction.Methods Ninety-five patients with cerebral infarction who were treated in our hospital from January 2016 to April 2018 were divided into two groups according to the time of intravenous thrombolytic therapy with alteplase. The observation group included patients with thrombolytic time <3 h, and the control group consisted of 50 patients with 3 to 4.5 h from onset to thrombolysis. The therapeutic effects, neurological recovery, cognitive function and cerebral hemorrhage were analyzed in the two groups.Results After 7-day treatment, there was no significant difference in the total effective rate between the two groups(88.9% vs. 82.0%, P>0.05). The NIHSS score and MESSS score were significantly higher after one-day and seven-day treatment with alteplase than those before treatment in two groups(all P<0.05). At the same time, the NIHSS scores and MESSS scores were significantly lower after one-day and seven-day treatment in the observation group[(7.13±2.42) points,(4.85±1.76) points for NIHSS and(8.48±2.72) points,(5.61±2.05) points for MESSS]than those of control group [(8.48±2.86) points,(6.08±2.31) points for NIHSS and(10.08±3.09) points,(7.23±2.81) points for MESSS, P<0.05]. After 7-day treatment, the MRS scores were significantly better in the observation group(good prognosis91.11%, poor prognosis 8.89% and no death) than those of the control group[good prognosis 76.00%, poor prognosis 20.00%and death 4.00%, P<0.05]. After 7-day treatment, the incidence rate of cerebral hemorrhage was 2.22% in the observation group, which was significantly lower than that of the control group(14.00%, χ~2=4.260, P<0.05).Conclusion Arteplase intravenous thrombolytic therapy(<3 h from onset to thrombolysis) can significantly improve the neurological and cognitive functions in patients with cerebral infarction and reduce the incidence of cerebral hemorrhage.
引文
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[9]Dorn F,Prothmann S,Patzig M,et al.Stent retriever thrombectomy in patients who are ineligible for intravenous thrombolysis:a multicenter retrospective observational study[J].AJNR Am JNeuroradiol,2016,37(2):305-310.doi:10.3174/ajnr.A4520.
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[11]Dharmasaroja PA,Muengtaweepongsa S.Outcomes of patients with large middle cerebral artery infarct treated with and without intravenous thrombolysis[J].J Neurosci Rural Pract,2016,7(1):36-39.doi:10.4103/0976-3147.172149.
[12]Mcdonald MM,Wetzel J,Fraser S,et al.Thrombelastography does not predict clinical response to rt PA for acute ischemic stroke[J].JThromb Thrombolysis,2016,41(3):505-510.doi:10.1007/s11239-015-1280-9.
[13]Goldman S,Prior SM,Bembenek JP,et al.Activation of blood coagulation and thrombin generation in acute ischemic stroke treated with rt PA[J].J Throm Thrombolysis,2017,44(3):362-370.doi:10.1007/s11239-017-1544-7.
[14]杨丹丹,陈慧丰,姚源蓉.缺血性进展性脑卒中的影响因素分析及预测[J].天津医药,2017,45(5):493-496.Yang DD,Chen HF,Yao YR.Analysis and prediction of influencing factors of ischemic progressive stroke[J].Tianjin Med J,2017,45(5):493-496.doi:10.11958/20170229.
[15]张敏,靳航,吴江.急性前循环脑梗死静脉溶栓患者TIBI分级与血管再通和预后的相关性研究[J].中风与神经疾病杂志,2018,35(1):30-34.Zhang M,Jin H,Wu J.The correlation study on thrombolysis in brain ischemia flow grades with the recanalization and outcomes of acute anterior circulation ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator[J].J Apoplexy and Nervous Diseases,2018,35(1):30-34.
[16]Mowla A,Kamal H,Lail NS,et al.Intravenous thrombolysis for acute ischemic stroke in patients with thrombocytopenia[J].JStroke Cerebrovasc Dis,2017,26(7):1414-1418.doi:10.1016/j.jstrokecerebrovasdis.2017.03.021.
[17]李克良,耿直.不同时间窗不同剂量阿替普酶治疗急性脑梗死的预后和安全性分析[J].现代仪器与医疗,2018,24(2):24-27.Li KL,Geng Z.Analysis of the prognosis and safety of alteplase when administered in different time windows or with different doses in the treatment of acute cerebral infarction[J].Modern Instru Med,2018,24(2):24-27.doi:10.11876/mimt201802010.
[2]Sagnier S,Galli P,Poli M,et al.The impact of intravenous thrombolysis on outcome of patients with acute ischemic stroke after90 years old[J].BMC Geriatr,2016,16(1):156-163.doi:10.1186/s12877-016-0331-1.
[3]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.Chinese Medical Association Neurology Branch,Chinese Medical Association,Neurology Branch,Cerebrovascular Disease Group.Guidelines for the diagnosis and treatment of acute ischemic cerebral infarction in China 2014[J].Chin J Neurol,2015,48(4):246-257.doi:10.3760/cma.j.issn.1006-7876.2015.04.002.
[4]中国卒中学会科学声明专家组.急性缺血性卒中静脉溶栓中国卒中学会科学声明[J].中国卒中杂志,2017,12(3):267-284.Chinese Stroke Institute Scientific Statement Expert Group.Acute Ischemic Stroke Intravenous Thrombolysis China Stroke Society Scientific Statement[J].Chin J Stroke,2017,12(3):267-284.doi:10.3969/j.issn.1673-5765.2017.03.017.
[5]Lyden P.Using the National Institutes of Health Stroke Scale:a cautionary tale[J].Stroke,2017,48(2):513-519.doi:10.1161/STROKEAHA.116.015434.
[6]Dijkland SA,Voormolen DC,Venema E,et al.Utility-Weighted Modified Rankin Scale as primary outcome in stroke trials:a simulation study[J].Stroke,2018,49(4):965-971.doi:10.1161/STROKEAHA.117.020194.
[7]Dorado L,Ahmed N,Thomalla G,et al.Intravenous thrombolysis in unknown-onset stroke:results from the safe implementation of treatment in stroke-international stroke thrombolysis registry[J].Stroke,2017,48(3):720-725.doi:10.1161/STROKEAHA.116.014889.
[8]Tsivgoulis G,Katsanos AH,Zand R,et al.Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke:a systematic review and meta-analysis[J].J Neurol,2017,264(6):1227-1235.doi:10.1007/s00415-017-8520-1.
[9]Dorn F,Prothmann S,Patzig M,et al.Stent retriever thrombectomy in patients who are ineligible for intravenous thrombolysis:a multicenter retrospective observational study[J].AJNR Am JNeuroradiol,2016,37(2):305-310.doi:10.3174/ajnr.A4520.
[10]Buijs JE,Uyttenboogaart M,Brouns R,et al.The effect of age and sex on clinical outcome after intravenous recombinant tissue plasminogen activator treatment in patients with acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2016,25(2):312-316.doi:10.1016/j.jstrokecerebrovasdis.2015.09.035.
[11]Dharmasaroja PA,Muengtaweepongsa S.Outcomes of patients with large middle cerebral artery infarct treated with and without intravenous thrombolysis[J].J Neurosci Rural Pract,2016,7(1):36-39.doi:10.4103/0976-3147.172149.
[12]Mcdonald MM,Wetzel J,Fraser S,et al.Thrombelastography does not predict clinical response to rt PA for acute ischemic stroke[J].JThromb Thrombolysis,2016,41(3):505-510.doi:10.1007/s11239-015-1280-9.
[13]Goldman S,Prior SM,Bembenek JP,et al.Activation of blood coagulation and thrombin generation in acute ischemic stroke treated with rt PA[J].J Throm Thrombolysis,2017,44(3):362-370.doi:10.1007/s11239-017-1544-7.
[14]杨丹丹,陈慧丰,姚源蓉.缺血性进展性脑卒中的影响因素分析及预测[J].天津医药,2017,45(5):493-496.Yang DD,Chen HF,Yao YR.Analysis and prediction of influencing factors of ischemic progressive stroke[J].Tianjin Med J,2017,45(5):493-496.doi:10.11958/20170229.
[15]张敏,靳航,吴江.急性前循环脑梗死静脉溶栓患者TIBI分级与血管再通和预后的相关性研究[J].中风与神经疾病杂志,2018,35(1):30-34.Zhang M,Jin H,Wu J.The correlation study on thrombolysis in brain ischemia flow grades with the recanalization and outcomes of acute anterior circulation ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator[J].J Apoplexy and Nervous Diseases,2018,35(1):30-34.
[16]Mowla A,Kamal H,Lail NS,et al.Intravenous thrombolysis for acute ischemic stroke in patients with thrombocytopenia[J].JStroke Cerebrovasc Dis,2017,26(7):1414-1418.doi:10.1016/j.jstrokecerebrovasdis.2017.03.021.
[17]李克良,耿直.不同时间窗不同剂量阿替普酶治疗急性脑梗死的预后和安全性分析[J].现代仪器与医疗,2018,24(2):24-27.Li KL,Geng Z.Analysis of the prognosis and safety of alteplase when administered in different time windows or with different doses in the treatment of acute cerebral infarction[J].Modern Instru Med,2018,24(2):24-27.doi:10.11876/mimt201802010.
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