超选择性动脉溶栓并术后局部亚低温对急性脑梗死患者血清NSE和S-100蛋白的影响  

Influence on serum NSE and S - 100 protein of patients with acute cerebral infarction by super selective intraarterial thrombolysis with locally mild hypothermia after surgery

作　　者：吕燕华[1] 曹亦宾[1] 郭红梅[1] 庄严[1] 王海英[1] 王素洁[1] 刘静华[1] 

机构地区：[1]唐山市工人医院神经内二科,河北唐山063000

出　　处：《中国急救医学》2014年第7期613-617,共5页Chinese Journal of Critical Care Medicine

基　　金：唐山市科学技术研究与发展指导计划项目（08130226c）

摘　　要：目的探讨超选择性动脉溶栓并术后局部亚低温治疗急性脑梗死的临床疗效及其对血清NSE和S-100蛋白的影响。方法选取具备溶栓指征的急性脑梗死患者120例，随机分为观察组与对照组，每组各60例。对照组予以尿激酶静脉溶栓，观察组予以超选择性动脉溶栓并术后局部亚低温治疗。于溶栓前后不同时点比较NIHSS评分及血清NSE和S-100蛋白含量，比较两组血管再通及临床疗效。结果溶栓后两组血清NSE均逐渐降低（t观察组=5．46—7．10，P〈0．01；t对照组=3．52～5．71，P〈0．05或P〈0．01），且观察组血清NSE均低于对照组相应时点（t=3．23～4．12，P〈0．05）。对照组溶栓前～溶栓后第1天、第3—7天血清S-100蛋白含量变化有统计学意义（t=3．41、4．50，P〈0．05）；观察组血清S-100蛋白含量逐渐降低（t=3，40—5．52，P〈0．05或P〈0．01），溶栓后第7、14天均低于对照组（t=3．79、4．83，P〈0．05）。溶栓后30min观察组与对照组NIHSS评分均显著降低（t观察组=6．83，t对照组=5．92，P〈0．01）；溶栓后各时点观察组NIHSS评分均低于对照组相应时点（t=3．81～6．77，P〈0．05或P〈0．01）。观察组与对照组血管再通率分别为88．33％、73．33％，临床总有效率分别为93．33％、78．33％，差异均有统计学意义（x^2=4．21，P〈0．05）。结论超选择性动脉溶栓并术后局部亚低温治疗急性脑梗死具有较好的临床疗效，溶栓后血管再通率较高，术后患者神经损伤恢复较快，血清NSE和S-100蛋白含量快速降低，效果显著优于单纯静脉溶栓。Objective To investigate the clinical effect of super selective intraarterial thrombolysis with locally mild hypothermia after surgery on serum neuronspecific enolase （NSE） and S - 100 protein of patients with acute cerebral infarction. Methods 120 patients with acute cerebral infarction and indication of thrombolytic therapy were selected, and were randomly divided into observation group and control group, 60 cases per group. Patients in control group were given intravenous thrombolytic therapy, and patients in observation group were given super selective intraarterial thrombolysis with locally mild hypothermia after surgery. NIHSS score, serum NSE and S - 100 protein in different time points before and after surgery, revascularization rate and clinical effect in two groups were compared. Results After thrombolytic therapy, two groups＇serum NSE were decreased one by one time point （t observation group = 5.46 - 7.10, P 〈 0.01 ; t control group = 3.52 - 5.71, P 〈0.05 or P 〈0.01 ）, and serum NSE at different time points in observation group were all lower than that in control group （t = 3.23 - 4. 12, P 〈 0.05 ）. Serum S - 100 protein in control group, before thrombolytic therapy, - 1 d after thrombolytic therapy and 3 d - 7 d after thrombolytic therapy were decreased gradually （ t = 3.41 and 4.50, respectively; P 〈 0.05 ）. Serum S - 100 protein in observation group was also decreased gradually （ t = 3.40 - 5.52, P 〈 0.05 or P 〈 0. 01 ）, and was lower than that in control group 7 d, 14 d after thrombolytic therapy （ t = 3.79 and 4.83, respectively; P 〈 0.05 ）. 30 min after thrombolysis, two groups＇ NIHSS score were both decreased gradually （ t observation group = 6. 83, t control group = 5.92, P 〈 0.01 ）. NIHSS scores in observation group were all lower than that in control group on each time point after thrombolysis （t =3. 81 -6.77, P 〈0. 05 or P 〈0.01）. Revascularization rate in observation group and control group were 88.33% and 73.33%, respectively; the t

关 键 词：急性脑梗死(ACI) 静脉溶栓 超选择性动脉溶栓 局部亚低温治疗 

分 类 号：R473.6[医药卫生—护理学]