摘要
目的探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓联合高压氧治疗急性脑梗死的临床疗效。方法采用随机数字表法将84例急性脑梗死患者分为rt-PA静脉溶栓组(rt-PA组)、rt-PA静脉溶栓联合高压氧治疗组(联合高压氧治疗组),每组42例。两组患者均在发病4.5h内采用静脉溶栓治疗,联合高压氧治疗组患者治疗同rt-PA组,且在用药基础上加用高压氧进行治疗。溶栓24h后复查两组患者头颅CT排除颅内出血后,予常规抗血小板聚集、调脂稳定斑块、改善循环、营养脑细胞代谢及酌情脱水等对症支持治疗。分别在治疗前、治疗1d、7d及21d采用美国国立卫生研究院卒中量表(NIHSS评分)来评估患者神经功能缺损的严重程度及评价疗效。结果与治疗前比较,两组治疗1、7、21d NIHSS评分均低于治疗前,差异均有统计学意义(均P<0.05)。随着时间延长,两组患者NIHSS评分均逐渐降低;联合高压氧治疗组患者治疗21d的NIHSS评分低于rt-PA组,差异有统计学意义(P<0.01)。联合高压氧治疗组基本治愈率高于rt-PA组,显著有效率低于rt-PA组,但差异无统计学意义(P>0.05)。两组患者均无一例死亡。两组患者症状性出血率比较,差异无统计学意义(χ^2=0.074,P>0.05)。结论rt-PA静脉溶栓联合高压氧治疗急性脑梗死疗效可能更好。
Objective To evaluate the efficacy of intravenous thrombolysis with hyperbaric oxygen therapy in the treatment of acute cerebral infarction.Methods Eighty four patients with acute cerebral infarction were randomly divided into two groups with 42 in each group.All patients were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)within 4.5 h after the onset of symptom;patients in combination group received additional hyperbaric oxygen treatment on the basis of intravenous thrombolysis.After 24 h of thrombolysis,patients in both groups were reexamined by head CT to exclude intracranial hemorrhage,and the supporting therapy of antiplatelet aggregation,lipid-regulating plaque stabilizations,circulation improvement,nourishing brain cells and appropriate dehydration was followed.The National Institutes of Health Stroke Scale(NIHSS score)evaluation and efficacy assessment were performed before and 1 d,7 d,21 d after therapy.Results The NIHSS scores at 1 d,7 d and 21 d after treatment were lower than those before treatment in both groups(P<0.05).With the extension of time,the NIHSS score in both groups gradually decreased;the NIHSS score of the combination group at 21 d after treatment was lower than that of the rt-PA group(P<0.01).There was no death in two groups,and no significant difference in symptomatic intracranial hemorrhage rate between two groups(χ^2=0.074,P>0.05).Conclusion The combined therapy of rt-PA with hyperbaric oxygen may be more effective than intravenous thrombolysis alone for acute cerebral infarction.
作者
胡灵芝
HU Lingzhi(Department of Neurology,Yongkang First People’s Hospital,Jinhua 321300,China)
出处
《浙江医学》
CAS
2019年第11期1204-1206,1217,共4页
Zhejiang Medical Journal
关键词
急性脑梗死
重组组织型纤溶酶原激活物
静脉溶栓
高压氧
Acute cerebral infarction
Recombinant tissue-type plasminogen activator
Intravenous thrombolysis
Hyperbaric oxygen
