Clinical study of intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator in the treatment of acute cerebral infarction
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目的 探讨血管内机械再通术联合重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床效果。 方法 随机对照研究。抽取2020年10月至2022年5月驻马店市中心医院收治的急性脑梗死患者108例，采用照随机数字表法将其分为对照组和观察组，每组54例。对照组在常规治疗基础上给予重组组织型纤溶酶原激活剂静脉溶栓治疗，观察组患者在常规治疗基础上给予血管内机械再通术联合重组组织型纤溶酶原激活剂静脉溶栓治疗。比较两组患者的临床疗效，比较两组治疗前、治疗后7 d的神经损伤标志物[中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)]、大脑动脉血流动力学指标[颈总动脉血流平均流速(Vmean)、最大流速(Vmax)、血管阻力指数(RI)、搏动指数(PI)]，并观察两组治疗后7 d内并发症发生情况。 结果 治疗后7 d，观察组治疗总有效率(92.59%，50/54)高于对照组(77.78%，42/54)，P<0.05。治疗后7 d，两组S100β、NSE指标均较同组治疗前降低，且观察组低于对照组(P<0.05)。治疗后，两组患者Vmean、Vmax值均较同组治疗前升高，且观察组高于对照组(P<0.05)；两组患者RI、PI指标均较同组治疗前降低，且观察组低于对照组(P<0.05)。两组治疗期间并发症发生率比较，差异未见统计学意义(P>0.05)。 结论 血管内机械再通术联合重组组织型纤溶酶原激活剂静脉溶栓治疗可改善急性脑梗死患者的大脑血流动力学指标，减少神经损伤，提高临床疗效。 Objective To investigate the clinical effect of intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator in the treatment of acute cerebral infarction. Methods This study was a randomized controlled trial. A total of 108 patients with acute cerebral infarction treated in Zhumadian Central Hospital from October 2020 to May 2022 were selected, and they were divided into control group and observation group by random number table method, with 54 cases in each group. The control group was treated by intravenous thrombolysis with recombinant tissue plasminogen activator on the basis of conventional treatment, and the observation group was treated by intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator and conventional treatment. The clinical efficacy of two groups were compared. The nerve injury markers, including central nervous specific protein (S100β) and neuron specific enolase (NSE), cerebral artery hemodynamics, including mean velocity (Vmean), maximum velocity (Vmax), vascular resistance index (RI) and pulsatility index (PI) of common carotid artery, were compared between the two groups before treatment and 7 days after treatment. The incidence of complications within 7 days after treatment in both groups were observed. Results After 7 days of treatment, the total effective rate of the observation group (92.59%, 50/54) was higher than that of the control group (77.78%, 42/54), P<0.05. After 7 days of treatment, the levels of S100β and NSE in both groups decreased, compared with preoperative levels in the same group (P<0.05) moreover, the above indicators in the observation group were lower than those in the control group (P<0.05). After treatment, the Vmean and Vmax of both groups were lower than those before treatment, while the Vmean and Vmax of the observation group were higher than those of the control group (P<0.05). The RI and PI in both groups were lower than those before treatment (P<0.05) moreover, the RI and PI in the observation group were lower than those in the control group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups during the treatment period (P>0.05). Conclusions Intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator can improve cerebral hemodynamics in patients with acute cerebral infarction, reduce nerve injury, and improve clinical efficacy.
Objective To investigate the clinical effect of intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator in the treatment of acute cerebral infarction. Methods This study was a randomized controlled trial. A total of 108 patients with acute cerebral infarction treated in Zhumadian Central Hospital from October 2020 to May 2022 were selected, and they were divided into control group and observation group by random number table method, with 54 cases in each group. The control group was treated by intravenous thrombolysis with recombinant tissue plasminogen activator on the basis of conventional treatment, and the observation group was treated by intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator and conventional treatment. The clinical efficacy of two groups were compared. The nerve injury markers, including central nervous specific protein (S100β) and neuron specific enolase (NSE), cerebral artery hemodynamics, including mean velocity (Vmean), maximum velocity (Vmax), vascular resistance index (RI) and pulsatility index (PI) of common carotid artery, were compared between the two groups before treatment and 7 days after treatment. The incidence of complications within 7 days after treatment in both groups were observed. Results After 7 days of treatment, the total effective rate of the observation group (92.59%, 50/54) was higher than that of the control group (77.78%, 42/54), P<0.05. After 7 days of treatment, the levels of S100β and NSE in both groups decreased, compared with preoperative levels in the same group (P<0.05) moreover, the above indicators in the observation group were lower than those in the control group (P<0.05). After treatment, the Vmean and Vmax of both groups were lower than those before treatment, while the Vmean and Vmax of the observation group were higher than those of the control group (P<0.05). The RI and PI in both groups were lower than those before treatment (P<0.05) moreover, the RI and PI in the observation group were lower than those in the control group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups during the treatment period (P>0.05). Conclusions Intravascular mechanical recanalization combined with intravenous thrombolysis with recombinant tissue plasminogen activator can improve cerebral hemodynamics in patients with acute cerebral infarction, reduce nerve injury, and improve clinical efficacy.
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