高压氧联合低剂量阿替普酶静脉溶栓治疗老年急性缺血性脑卒中的疗效及对患者神经认知功能、凝血指标的影响

摘要 目的：评价高压氧（HBO）联合低剂量阿替普酶（rtPA）静脉溶栓治疗老年急性缺血性脑卒中（AIS）的疗效及对患者神经认知功能、凝血指标的影响。方法：选入我院2020年1月~2022年12月收治的老年AIS患者60例，随机分为对照组和观察组，各30例。对照组予以HBO+标准剂量（0.9 mg/kg）rtPA静脉溶栓治疗，观察组采用HBO+低剂量（0.6 mg/kg）rtPA治疗。评价两组的治疗效果、神经认知功能及凝血指标等，并进行统计比较。结果：两组治疗总有效率无明显差异（P＞0.05）；与溶栓前比较，两组溶栓后24 h、7 d时的NIHSS显著下降、MMSE明显升高（P＜0.05），但两组之间无明显差异（P＞0.05）；相较于溶栓前，两组溶栓后7 d时PT、APTT、TT、D-D不同程度增加，Fib明显下降（P＜0.05），而观察组增加/下降幅度较小，与对照组差异显著（P＜0.05）；观察组出血率明显低于对照组（6.67% vs 26.67%，P＜0.05）；两组死亡率无明显差异（P＞0.05）。结论：HBO联合低剂量与标准剂量rtPA静脉溶栓在改善AIS患者神经认知功能、临床疗效及死亡率方面效果相当，但低剂量对血凝功能影响小，同时出血发生风险低。

Effect of Hyperbaric Oxygen Combined with Low-dose Ateplase Intravenous Thrombolysis on Neurocognitive Function and Coagulation Parameters in Elderly Patients with Acute Ischemic Stroke

ABSTRACT Objective: To evaluate the efficacy of hyperbaric oxygen (HBO) combined with low dose alteplase (rtPA) intravenous thrombolysis in the treatment of elderly patients with acute ischemic stroke (AIS) and its impact on neurocognitive function and coagulation indicators. Methods: Sixty elderly patients with AIS admitted to our hospital from January 2020 to December 2022 were randomly divided into a control group and an observation group, with 30 patients in each group. The control group was treated with HBO+standard dose (0.9 mg/kg) rtPA intravenous thrombolysis, while the observation group was treated with HBO+low dose (0.6 mg/kg) rtPA. The therapeutic effects, neurocognitive function, and coagulation indicators of the two groups were evaluated and statistically compared. Results: There was no significant difference in the total effective rate between the two groups(P>0.05). Compared with pre thrombolysis, NIHSS significantly decreased and MMSE significantly increased in the two groups at 24 h and 7 d after thrombolysis(P<0.05), but there was no significant difference between the two groups(P>0.05). Compared to before thrombolysis, PT, APTT, TT, and D-D in the two groups increased to varying degrees at 7 days after thrombolysis, while FIB decreased significantly(P<0.05), while the increase/decrease amplitude in the observation group was smaller, with a significant difference compared to the control group(P<0.05). The bleeding rate in the observation group was significantly lower than that in the control group (6.67% vs 26.67%, P<0.05). There was no significant difference in mortality between the two groups(P>0.05). Conclusion: HBO combined with low dose and standard dose rtPA intravenous thrombolysis has a similar effect on improving neurocognitive function, clinical efficacy, and mortality in AIS patients, but low dose has a small impact on blood coagulation function and a low risk of bleeding.