标题：神经介入联合阿替普酶静脉溶栓对急性缺血性脑卒中患者脑血流动力学及神经功能的影响

      作者：陈静 1，谢闯洲 2    1.榆林市星元医院神经内二科，陕西 榆林 719000；2.陕西省森工医院血管外科，陕西 西安 710061

      卷次： 2020年31卷5期

      【摘要】 目的 探究神经介入联合阿替普酶静脉溶栓对急性缺血性脑卒中(AIS)患者脑血流动力学及神经功能的影响，为患者的治疗提供参考。方法 回顾性分析榆林市星元医院神经内二科2015年12月至2018年12月收治的102例AIS患者的临床诊治资料，按照患者治疗方式将其分为观察组50例和对照组52例。对照组患者采用阿替普酶静脉溶栓治疗，观察组在对照组治疗的基础上联合神经介入治疗，连续治疗3个月，比较患者治疗后的临床疗效、脑血流动力学各项指标水平以及治疗前后的神经功能缺损评分(NIHSS)。结果 治疗后观察组患者的治疗总有效率为96.0%，明显高于对照组的86.5%，差异有统计学意义(P<0.05)；治疗后，观察组和对照组患者的血流速度 (Vmin) [(9.9±1.8) cm/s vs (9.1±1.5) cm/s]、最小血流量 (Qmin) [(4.9±1.2) mL/s vs (4.2±1.3) mL/s ]、动态阻抗 (DR)[(483.5±156.2) Pa·s/mL vs (418.4±159.2) Pa·s/mL]比较，观察组明显高于对照组，脑血管外周阻力(R) [(1 825.3±251.5) Pa·s/mL vs 1 965.5±261.8 Pa·s/m]、临界压力(CP) [(6.2±1.6) kPa vs (6.9±1.6) kPa]比较，观察组明显低于对照组，差异均有统计学意义(P<0.05)，而脉搏波速(Wv) [(20.9±3.9) m/s vs (20.8±4.1) m/s ]比较差异无统计学意义(P>0.05)；两组患者治疗前的NIHSS评分比较差异无统计学意义(P>0.05)；治疗 24 h和治疗 3个月后，观察组患者的NIHSS评分分别为(16.4±3.1)分，(11.3±2.1)分，明显低于对照组的(19.5±3.6)分，(15.8±2.9)分，差异均有统计学意义(P<0.05)。结论 神经介入联合阿替普酶静脉溶栓治疗急性缺血性脑卒中临床疗效显著，能明显改善患者的神经功能，值得推广应用。
      【关键词】 急性缺血性脑卒中；神经介入；阿替普酶；静脉溶栓；疗效；神经功能
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2020）05—0579—03

Effect of neurointervention combined with intravenous thrombolysis with alteplase on cerebral hemodynamicsand neurological function in patients with acute ischemic stroke.
CHEN Jing 1, XIE Chuang-zhou 2. 1. SecondDepartment of Neurology, Yulin Xingyuan Hospital, Yulin 719000, Shaanxi, CHINA; 2. Department of Vascular Surgery,Shaanxi Sengong Hospital, Xi'an 710061, Shaanxi, CHINA
【Abstract】 Objective To investigate the effects of neurointervention combined with intravenous thrombolysiswith alteplase on cerebral hemodynamics and neurological function in patients with acute ischemic stroke (AIS), andto provide reference for the treatment of patients. Methods The clinical diagnosis and treatment data of 102 AIS pa-tients admitted to the Second Department of Neurology, Yulin Xingyuan Hospital from December 2015 to December2018 were analyzed retrospectively. According to the treatment mode, the patients were divided into the observationgroup (n=50) and control group (n=52). The patients in the control group were treated with intravenous thrombolysiswith alteplase, and those in the observation group were treated with neurointerventional therapy on the basis of thetreatment in the control group for three months. The clinical effect, the level of various indexes of cerebral hemody-namics and the National Institutes of Health Stroke Scale (NIHSS) score in two groups before and after the treatmentwere compared. Results After treatment, the total effective rate of the observation group was 96.0%, which was signifi-cantly higher than 86.5% of the control group (P<0.05); the blood flow velocity (Vmin), minimum blood flow (Qmin), dy-namic resistance (DR) of the observation group were (9.9±1.8) cm/s, (4.9±1.2) mL/s, (483.5±156.2) Pa·s/mL, whichwere significantly higher than corresponding (9.1 ± 1.5) cm/s, (4.2 ± 1.3) mL/s, (418.4 ± 159.2) Pa·s/mL in the controlgroup; while the peripheral resistance (R) and critical pressure (CP) were (1 825.3±251.5) Pa·s/mL and (6.2±1.6) kPa,which were significantly lower than corresponding (1 965.5±261.8) Pa·s/mL and (6.9±1.6) kPa in the control group(all P<0.05); there was no significant difference in Wv (pulse wave velocity) between the two groups: (20.9±3.9) m/svs (20.8±4.1) m/s, P>0.05. There was no significant difference between the two groups in NIHSS score before treat-ment (P>0.05). After 24 hours and 3 months of treatment, the NIHSS scores of the observation group was 16.4±3.1,11.3±2.1, respectively, which were significantly lower than corresponding 19.5±3.6 and 15.8±2.9 of the control group(P<0.05). Conclusion Neurointerventional therapy combined with intravenous thrombolysis with alteplase has a signifi-cant clinical effect in the treatment of acute ischemic stroke, which can significantly improve the neurological function ofpatients, and is worthy of promotion and application.
      【Key words】 Acute ischemic stroke (AIS); Neurological intervention; Alteplase; Intravenous thrombolysis; Ther-apeutic eff