目的:研究阿替普酶联合低分子肝素超早期溶栓治疗急性缺血性脑卒中的临床应用.方法:回顾性收集 2020年 7 月至 2023 年 7 月期间本院收治的 103 例急性缺血性脑卒中患者的临床资料,依据治疗方式的不同分为对照组(n=51)和试验组(n=52),分别予以阿替普酶 50 mg静脉泵注或低分子肝素 0.4 mL皮下注射超早期溶栓联合阿替普酶治疗.分析治疗 14 d后临床疗效,治疗前、治疗 14 d后采用美国国立卫生院量表(National Institute of Health stroke scale,NIHSS)评估神经功能,采用XTG-1600型流式细胞仪测定血液流变学指标(全血低切还原黏度、血浆黏度、全血高切还原黏度),采用酶联免疫吸附法测定血小板功能指标;并记录治疗 1 m的不良反应.结果:治疗 14 d后,试验组临床总有效率高于对照组(P＜0.05);试验组NIHSS评分、各项血液流变学指标、血小板膜糖蛋白CD63 阳性率、血小板膜糖蛋白CD62p阳性率、血小板P选择素低于对照组(P＜0.05).两组均未见严重不良反应.结论:阿替普酶+低分子肝素超早期溶栓治疗急性缺血性脑卒中患者具有显著疗效,可改善血液流变学、血小板功能.
Comparative study on the clinical application of alteplase combined with low molecular weight heparin in the treatment of acute ischemic stroke
Objective:To study the clinical application of ultra-early thrombolytic therapy with alteplase combined with low molecular weight heparin for acute ischemic stroke.Methods:A retrospective collection of clinical data was conducted for 103 patients with acute ischemic stroke admitted to our hospital from July 2020 to July 2023.Based on different treatment methods,they were divided into a control group(n=51)and a test group(n=52),and were treated with ultra-early thrombolysis with intravenous infusion of alteplase 50 mg or subcutaneous injection of low molecular weight heparin 0.4 mL combined with alteplase treatment.The clinical efficacy was analyzed after 14 days of treatment.Before and after treatment,the National Institute of Health stroke scale(NIHSS)was used to assess neurological function,and the XTG-1600 flow cytometer was used to measure blood rheology indicators(whole blood low shear reduced viscosity,plasma viscosity,whole blood high shear reduced viscosity).Platelet function indicators were measured using enzyme-linked immunosorbent assay,and adverse reactions were recorded after 1 month of treatment.Results:After 14 days of treatment,the total clinical efficacy rate in the experimental group was higher than that in the control group(P<0.05).NIHSS score,various hemorheology indicators,platelet membrane glycoprotein CD63 positive rate,platelet membrane glycoprotein CD62p positive rate,and platelet P-selectin in the experimental group were lower than those in the control group(P<0.05).No serious adverse reactions were observed in both groups.Conclusion:The ultra-early thrombolytic therapy with alteplase and low molecular weight heparin for patients with acute ischemic stroke has significant efficacy and can improve hemorheology and platelet function.
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