[1]李乐,常保强,黄丽霞,等.rt-PA静脉溶栓联合亚低温治疗急性脑梗死效果[J].青岛大学学报(医学版),2018,54(04):450-453,457.[doi:10.11712/jms201804018]
 LI Le,CHANG Baoqiang,HUANG Lixia,et al.CLINICAL EFFECT OF RT-PA INTRAVENOUS THROMBOLYSIS COMBINED WITH MILD HYPOTHERMIA IN TREATMENT OF ACUTE CEREBRAL INFARCTION[J].JOURNAL OF QINGDAO UNIVERSITY (MEDICAL SCIENCES),2018,54(04):450-453,457.[doi:10.11712/jms201804018]
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rt-PA静脉溶栓联合亚低温治疗急性脑梗死效果()
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《青岛大学学报(医学版)》[ISSN:2096-5532/CN:37-1217/R]

卷:
第54卷
期数:
2018年04期
页码:
450-453,457
栏目:
出版日期:
2018-07-05

文章信息/Info

Title:
CLINICAL EFFECT OF RT-PA INTRAVENOUS THROMBOLYSIS COMBINED WITH MILD HYPOTHERMIA IN TREATMENT OF ACUTE CEREBRAL INFARCTION
文章编号:
2096-5532(2018)04-0450-05
作者:
李乐常保强黄丽霞戴永武
(惠州市第三人民医院神经内科,广东 惠州 516000)
Author(s):
LI Le CHANG Baoqiang HUANG Lixia DAI Yongwu
(Department of Neurology, Third People’s Hospital of Huizhou City, Huizhou 516000, China)    
关键词:
脑梗死血栓溶解疗法低温氧化性应激治疗结果
Keywords:
brain infarction thrombolytic therapy hypothermia oxidative stress treatment outcome
分类号:
R743.33;R453.9
DOI:
10.11712/jms201804018
文献标志码:
A
摘要:
目的 探讨重组人组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合亚低温治疗急性脑梗死(ACI)病人的临床效果及安全性。
方法 选取我院2015年1月—2017年4月收治的50例ACI病人,按照随机数字表法分为试验组和对照组,每组25例。对照组给予rt-PA静脉溶栓治疗,试验组在此基础上联合局部亚低温治疗24 h。比较两组病人临床疗效、美国国立卫生院神经功能缺损评分(NIHSS评分)、改良Rankin量表(mRS)评分及氧化应激反应、炎症因子水平。
结果 试验组和对照组临床总有效率分别为96%和72%,差异有统计学意义(χ2=4.577,P<0.05)。治疗后两组病人NIHSS评分均较治疗前明显下降,试验组治疗后7、14 d的NIHSS评分明显低于对照组,差异具有统计学意义(t=2.132、2.612,P<0.05)。治疗后3个月,试验组mRS评分显著低于对照组(t=8.014,P<0.05)。治疗后两组病人超氧化物歧化酶(SOD)水平明显上升,丙二醛(MDA)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)水平明显下降;治疗后72 h,试验组SOD水平明显高于对照组,MDA、TNF-α、IL-1β水平明显低于对照组,差异具有统计学意义(t=5.446~20.203,P<0.05)。试验组并发症发生率和病死率分别为12%和4%,对照组分别为16%和4%,两组比较差异无统计学意义(P>0.05)。
结论 rt-PA静脉溶栓联合亚低温治疗ACI效果显著,可明显降低机体氧化应激反应和炎症因子水平,改善病人神经功能缺损情况,安全可靠,值得临床推广。
Abstract:
Objective To investigate the clinical effect and safety of intravenous thrombolysis with recombinant human tissue plasminogen activator (rt-PA) combined with mild hypothermia in the treatment of acute cerebral infarction (ACI).
Methods A total of 50 patients with ACI who were admitted to our hospital from January 2015 to April 2017 were divided into experimental group and control group using a random number table, with 25 patients in each group. The patients in the control group were given intravenous thrombolysis with rt-PA, and those in the experimental group were given local mild hypothermia for 24 h in addition to the treatment in the control group. The two groups were compared in terms of clinical outcome, National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, oxidative stress response, and levels of inflammatory factors.
Results There was a significant difference in overall response rate between the experimental group and the control group (96% vs 72%, χ2=4.577,P<0.05). Both groups had a significant reduction in NIHSS score after treatment, and on days 7 and 14 after treatment, the experimental group had a significantly lower NIHSS score than the control group (t=2.132 and 2.612,P<0.05). At 3 months after treatment, the experimental group had a significantly lower mRS score than the control group (t=8.014,P<0.05). After treatment, both groups had a significant increase in superoxide dismutase (SOD) and significant reductions in malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β); at 72 h after treatment, the experimental group had a significantly higher level of SOD and significantly lower levels of MDA, TNF-α, and IL-1β than the control group (t=5.446-20.203,P<0.05). There were no significant differences between the experimental group and the control group in the incidence rate of complications (12% vs 16%,P>0.05) and mortality rate (4% vs 4%,P>0.05).
Conclusion Intravenous thrombolysis with rt-PA combined with mild hypothermia has a marked clinical effect in the treatment of ACI and can significantly reduce oxidative stress response and levels of inflammatory factors and improve neurological deficit. It is safe and reliable and thus holds promise for clinical application.
更新日期/Last Update: 2018-07-08