阿替普酶联合依达拉奉治疗急性缺血性卒中的疗效及神经功能缺损与时间窗的关系研究

目的:探讨阿替普酶联合依达拉奉治疗急性缺血性卒中的疗效及神经功能缺损与时间窗的关系。方法:选取大连医科大学附属大连市中心医院于2016年3月~2018年10月间收治的急性缺血性卒中患者117例,根据随机数字表法将患者分为对照组(n=58,阿替普酶治疗)和研究组(n=59,阿替普酶联合依达拉奉治疗),比较两组患者临床疗效、神经功能缺损情况、基质金属蛋白酶-9(MMP-9)、白介素-6(IL-6)水平、头颅CT梗死面积,观察两组治疗期间不良反应发生情况。结果:研究组的总有效率为84.75%(50/59),高于对照组的63.79%(37/58)(P<0.05)。两组患者治疗2周后MMP-9、IL-6、美国国立卫生研究院卒中量表(NIHSS)评分均较治疗前降低,且研究组低于对照组(P<0.05)。研究组治疗24h、48h、72h的头颅CT梗死面积小于对照组(P<0.05)。治疗后研究组发病72h内、发病48h内患者NIHSS评分、头颅CT梗死面积高于发病24h内,且发病72h内高于发病48h内(P<0.05)。两组患者不良反应发生率比较无差异(P>0.05)。结论:阿替普酶联合依达拉奉治疗急性缺血性卒中,疗效确切,可有效改善患者过氧化损伤,降低细胞因子水平,且越早的时间窗内接受治疗的患者,其神经功能缺损、脑梗死面积改善效果越好。

The Efficacy of Alteplase Combined with Edaravone on Acute Ischemic Stroke and the Relationship between Neurological Deficit and Time Window

ABSTRACT Objective: To investigate the efficacy of alteplase combined with edaravone in the treatment of acute ischemic stroke and the relationship between neurological deficit and time window. Methods: 117 patients with acute ischemic stroke who were admitted to Dalian Central Hospital Affiliated Of Dalian Medical University from March 2016 to October 2018 were selected, they were divided into control group (n=58, alteplase treatment) and study group (n=59, alteplase combined with edaravone treatment) according to random number table method. The clinical efficacy, neurological deficits, levels of matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6) and infarct size of cranial CT were compared between the two groups. The occurrence of adverse reactions during the treatment of the two groups were observed. Results: The total effective rate of the study group was 84.75% (50/59), which was higher than 63.79% (37/58) of the control group (P<0.05). 2 weeks after treatment, the MMP-9, IL-6 and scores of National Institutes of Health Stroke Scale (NIHSS) in both groups were lower than those before treatment, and those in the study group were lower than those in the control group (P<0.05). The infarct size of cranial CT of study group at 24h, 48h and 72h after treatment was smaller than that of control group (P<0.05). The scores of NIHSS and infarct size of cranial CT of study group patients within 72h and 48h of onset were higher than those within 24h of onset, and those within 72h of onset were higher than those within 48 hours of onset (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Alteplase combined with edaravone in the treatment of acute ischemic stroke has definite effect. It can effectively improve the peroxidation injury and reduce the level of cytokines. The earlier the patients are treated within the time window, the better the improvement of neurological deficit and cerebral infarct size.