重组组织型纤溶酶原激活剂动脉溶栓联合依达拉奉右莰醇的临床疗效分析  

Efficacy of recombinant tissue plasminogen activator combined with edaravone and dexborneol for arterial thrombolysis

作　　者：魏列君 赵丽丽 李晓 Wei Liejun;Zhao Lili;Li Xiao(Department of Neurology,Liangzhou Hospital of Wuwei City,Wuwei 733000,Gansu Province,China)

机构地区：[1]武威市凉州医院神经内科,733000 [2]武威市凉州医院影像科,733000

出　　处：《中华老年心脑血管病杂志》2024年第8期916-920,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：武威市科学技术局民生科技专项项目(WW23B02SF022)。

摘　　要：目的分析老年后循环穿支动脉型脑梗死患者在接受重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activators,rt-PA)动脉溶栓治疗的基础上使用依达拉奉右莰醇的临床治疗效果。方法纳入2021年8月至2023年8月于武威市凉州医院接受治疗的老年急性脑梗死患者68例,根据随机数字表法分为溶栓组和联合组,每组各34例,溶栓组使用rt-PA动脉溶栓治疗,联合组在溶栓组的基础上联合依达拉奉右莰醇治疗。比较2组患者的治疗效果、神经功能情况、氧化应激反应、炎性反应、日常生活功能以及不良事件发生情况。结果2组治疗总有效率比较,差异无统计学意义(P>0.05)。2组治疗14 d后血清神经元特异性烯醇化酶、基质金属蛋白酶9、中枢神经特异性蛋白β、丙二醛、白细胞介素6、C反应蛋白水平、改良的Rankin量表评分、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分均低于治疗前(P<0.05),且联合组治疗14 d后神经元特异性烯醇化酶、基质金属蛋白酶9、中枢神经特异性蛋白β、丙二醛、白细胞介素6、C反应蛋白水平、改良的Rankin量表评分、NIHSS评分均低于溶栓组(P<0.05,P<0.01);联合组治疗90 d后NIHSS评分低于溶栓组[(6.15±0.92)分vs(7.48±0.83)分,P<0.01]。2组治疗14 d后超氧化物歧化酶水平、Barthel指数量表评分均高于治疗前(P<0.05),且联合组治疗14 d后超氧化物歧化酶水平、Barthel指数量表评分高于溶栓组(P<0.01)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论老年后循环穿支动脉型脑梗死患者在接受rt-PA动脉溶栓治疗的同时联合使用依达拉奉右莰醇的临床疗效较好,可以降低氧化应激和炎性反应,改善患者的脑组织损伤情况及神经功能状况,同时提高日常生活能力且安全性较好。Objective To analyze the clinical therapeutic efficacy of edaravone and dexborneol in elderly patients with posterior circulation perforating arterial cerebral infarction after receiving rt-PA for arterial thrombolysis.Methods A total of 68 elderly patients with acute cerebral infarction who were treated in our hospital from August 2021 to August 2023 were enrolled and then randomly divided into thrombolytic group and combined group,with 34 cases in each group.The thrombolytic group was treated with rt-PA arterial thrombolysis,and the combined group was treated with edaravone and dexborneol on the basis of thrombolytic group.The therapeutic efficacy,neurological function,oxidative stress reaction,inflammatory reaction,ADL,and incidence of adverse events were compared between the two groups.Results There was no significant difference in the total effective rate between the two groups(P>0.05).Serum levels of NSE,MMP-9,S100β,MDA,IL-6 and CRP,and the scores of mRS and NIHSS were all decreased in the two groups in 14 d after treatment than before treatment(P<0.05),and the levels of NSE,MMP-9,S100β,MDA,IL-6 and CRP,and mRS score and NIHSS score were obviously lower in the combined group than the thrombolytic group at the time point(P<0.05,P<0.01).After 90 days'treatment,the combined group obtained notably lower NIHSS score than the thrombolytic group(6.15±0.92 vs 7.48±0.83,P<0.01).After 14 days of treatment,the level of SOD and Barthel index in the two groups were higher than those before treatment(P<0.05),and the two indicators in the combined group were higher than those in the thrombolytic group(P<0.01).No statistical difference was observed in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Concurrent administration of edaravone and dexborneol shows good clinical efficacy for elderly patients with cerebral infarction with perforating artery of posterior circulation after rt-PA arterial thrombolytic therapy,and at the same time,the combination of edaravone and dextromethorphan

关 键 词：脑梗死 血栓溶解疗法 纤溶酶原激活剂 依达拉奉 

分 类 号：R743.33[医药卫生—神经病学与精神病学]