同时使用Cerebrolysin和阿替普酶对脑梗死的影响与脑梗死出血性转化的相关因素分析  

Analysis of factors associated with effects of concomitant use of cerebrolysin and alteplase on cerebral infarction and hemorrhagic transformation of cerebral infarction

作　　者：王钰 王天才 李梦龙 杨丰 杨栋 黄露 李坷 WANG Yu;WANG Tian-cai;LI Meng-long;YANG Feng;YANG Dong;HUANG Lu;LI Ke(Department of Neurology,Nanshi Hospital of Nanyang,Nanyang,Henan 473000,China;Department of Critical Care Medicine,Nanshi Hospital of Nanyang,Nanyang,Henan 473000,China)

机构地区：[1]南阳南石医院神经内科,河南南阳473000 [2]南阳南石医院重症医学科,河南南阳473000

出　　处：《医药论坛杂志》2024年第13期1452-1456,F0003,共6页Journal of Medical Forum

摘　　要：目的探究同时使用Cerebrolysin和阿替普酶治疗脑梗死的效果,并分析脑梗死出血性转化(hemorrhagic transformation,HT)影响因素。方法前瞻性选取2021年9月至2023年9月南阳南石医院收治的498例脑梗死患者为研究对象,所有患者均接受Cerebrolysin和阿替普酶同时使用治疗方案,分析同时使用Cerebrolysin和阿替普酶治疗脑梗死的疗效、治疗前后功能综合评定量表(FCA)的变化与HT发生状况,并通过二元logistic回归分析HT发生的影响因素。结果498例患者经治疗后,基本痊愈347例(69.68%)、显效84例(16.87%)、有效58例(11.65%)、无效9例(1.81%)。配对样本t检验结果显示,治疗后FCA评分显著高于治疗前,差异具有统计学意义(P<0.05)。治疗14 d后发生HI1为26例(5.22%)、HI2为10例(2.01%)、PH 1为8例(1.61%),总发生HT为44例(8.84%);且HT组治疗后FCA评分低于非HT组(P<0.05)。二元logistic回归分析显示,心房颤动、服用抗血小板药物、BMI、基线血糖、溶栓24 h后收缩压、基线NIHSS评分、发病至溶栓治疗时间均为HT发生危险因素(P<0.05)。结论同时使用Cerebrolysin和阿替普酶治疗脑梗死具有较好疗效,可有效改善患者功能结局,且HT发生率较低,心房颤动、服用抗血小板药物、BMI、基线血糖、溶栓24 h后收缩压、基线NIHSS评分、发病至溶栓治疗时间均为HT发生危险因素。临床需加强重视。Objective To investigate the effect of simultaneous use of Cerebrolysin and alteplase in the treatment of cerebral infarction and to analyze the factors affecting hemorrhagic transformation(HT)in cerebral infarction.Methods Prospectively selected 498 patients with cerebral infarction admitted to our hospital from September 2021 to September 2023 as the study object,all patients received both Cerebrolysin and atteplase,analyzed the efficacy of Cerebrolysin and atteplase for cerebral infarction,the change of functional rating scale(FCA)before and after treatment and the occurrence of HT by binary logistic regression.Results After treatment,347(69.68%)patients recovered,84(16.87%),58(11.65%)and 9(1.81%).The paired sample t-test results showed that the FCA score after treatment was significantly higher than that before treatment,and the difference was statistically significant(P<0.05).After 14d of treatment,HI 1 was 26(5.22%),HI 210(2.01%),and PH 18(1.61%),the total HT was 44(8.84%);and the FCA score in the HT group was lower than that in the non-HT group(P<0.05).Binary logistic regression analysis showed that atrial fibrillation,antiplatelet medication,BMI,baseline blood glucose,baseline NIHSS score,and onset to thrombolytic therapy were all risk factors for HT(P<0.05).Conclusion The simultaneous treatment of Cerebrolysin and alteplase for cerebral infarction have good efficacy and effectively improved the functional outcome of patients,and the incidence of HT is low.AF fibrillation,antiplatelet medication,BMI,baseline blood glucose,systolic blood pressure after 24 h,baseline NIHSS score,and time from onset to thrombolytic therapy are all risk factors for HT.Clinical attention should be strengthened.

关 键 词：脑梗死 CEREBROLYSIN 阿替普酶 疗效 出血性转化 功能结局 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]