Solitaire AB支架机械取栓联合阿替普酶静脉溶栓对急性缺血性脑卒中患者的临床研究

目的:探讨急性缺血性脑卒中患者运用阿替普酶静脉溶栓联合Solitaire AB支架机械取栓对其神经保护因子、血液流变学及免疫功能的影响。方法:将我院于2017年4月~2019年3月期间收治的急性缺血性脑卒中患者113例以双色球随机分组法分为研究组(Solitaire AB支架机械取栓联合阿替普酶静脉溶栓)和对照组(阿替普酶静脉溶栓),分别为57例和56例。比较两组患者疗效、神经功能、血管再通率、神经保护因子、血液流变学及免疫功能,并记录两组治疗期间不良反应状况。结果:研究组治疗后3个月的总有效率为91.22%(52/57),高于对照组的76.79%(43/56)(P<0.05)。研究组的血管再通率高于对照组(P<0.05)。两组不良反应发生率对比未见统计学差异(P>0.05)。两组治疗后3个月的CD8⁺、美国国立卫生研究所卒中量表(NIHSS)评分、纤维蛋白原、全血黏度、神经胶质原纤维酸性蛋白(GFAP)及血浆黏度均较治疗前降低,且研究组低于对照组(P<0.05)。CD3⁺、CD4⁺、CD4⁺/CD8⁺、胰岛素样生长因子-1(IGF-1)、脑源性神经营养因子(BDNF)均升高,且研究组高于对照组(P<0.05)。结论:急性缺血性脑卒中患者在阿替普酶静脉溶栓治疗的基础上联合Solitaire AB支架机械取栓治疗,安全有效,能够改善机体的免疫功能及血液流变学,减轻神经功能损害,并提高患者血管再通率。

Clinical Study of Mechanical Thrombectomy with Solitaire AB Stent and Intravenous Thrombolysis with Alteplase in Patients with Acute Ischemic Stroke

Objective: To investigate the effect of alteplase intravenous thrombolysis combined with mechanical thrombectomy with solitaire AB stent on neuroprotective factors, hemorheology and immune function in patients with acute ischemic stroke. Methods:113 patients with acute ischemic stroke were treated in our hospital from April 2017 to March 2019, they were divided into study group(mechanical thrombectomy with solitaire AB stent combined with alteplase) and control group(alteplase therapy), according to two color ball random grouping method, 56 cases and 57 cases respectively. Patients in the control group were treated with intravenous thrombolysis with alteplase. The study group was combined with solitaire on the basis of the control group The therapeutic effect,neurological function, vascular recanalization rate, neuroprotective factor, hemorheology and immune function of the two groups were compared, the adverse reactions during were recorded. Results: The total effective rate of the study group was 91.22%(52/57) three months after treatment, which was higher than 76.79%(43/56) of the control group(P<0.05). The recanalization rate in the study group was higher than that in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). The CD8⁺, National Institutes of Health Stroke Scale(NIHSS) scores, fibrinogen, whole blood viscosity, Glial fibrillary acidic protein(GFAP) and plasma viscosity in the two groups were lower than those in the control group(P<0.05). CD3⁺, CD4⁺,CD4⁺/CD8⁺, insulin-like growth factor-1(IGF-1), brain derived neurotrophic factor(BDNF) were all increased in the study group, which were higher than those in the control group(P<0.05). Conclusion: The combination of alteplase intravenous thrombolysis and Solitaire AB stent mechanical thrombectomy is safe and effective for patients with acute ischemic stroke. It can improve the immune function and hemorheology of the body, reduce the damage of neurological function, and improve the recanalization rate of patients.