介入与溶栓治疗急性心肌梗死的近期临床疗效比对研究

目的探讨分析介入与溶栓治疗急性心肌梗死的近期临床疗效。方法随机选取2009年5月~2011年6月因急性心肌梗死就诊于我院进行治疗的患者170例,随机分为治疗组(采用介入治疗)85例患者,对照组(采用静脉溶栓治疗)85例患者,观察总结两组患者治疗后心肌梗死、心肌缺血的复发情况,并对两组结果进行统计学分析。结果治疗组患者治疗后再次发生心肌梗死以及心肌缺血的总发生率为15.3%,疗效明显好于对照组,经统计分析,P0.05,差异存在显著性。结论介入治疗急性心肌梗死能有效提高治疗效果,并且降低再次发生心肌梗死以及心肌缺血的发生率。     

Diabetes mellitus inhibits complete recanalization in patients with middle cerebral artery occlusion

Methods: This was a retrospective cohort study. Data from 165 patients, with middle cerebral occlusion before t-PA therapy (from the YAMATO study databank), were retrospectively evaluated. Patients were classified into diabetic (D) or non-diabetic (ND) groups based on the history of diabetes mellitus (DM) or hemoglobin A1c levels of ≥ 6.5%. Arterial recanalization was assessed using magnetic resonance angiography or digital subtraction angiography at 2 points: 1) early recanalization, within 2 h; 2) delayed complete recanalization at 24 h. Good clinical outcome was defined as modified Rankin Scale score 0–2 at 3 months.

Results: A total of 33 (21%) were classified into the D and 127 (79%) in the ND groups. Early recanalization was similarly in the D and ND groups (61% vs. 52%, p = 0.434). However, complete recanalization at 24 h was infrequent in the D group (13% vs. 43%, p = 0.002). Among patients with early recanalization, 4 (22%) of 18 patients in the D group and 32 (56%) of 57 patients in the ND group had complete recanalization at 24 h (p = 0.015); while among those without early recanalization, 17 (30%) in the ND and none in the D groups had complete recanalization at 24 h (p = 0.028). Multivariate regression analysis showed DM was one of the independent negative factors for complete recanalization at 24 h (odds ratio 0.113, 95%CI: 0.027–0.472, p = 0.003). At 3 months, group with complete recanalization at 24 h achieved higher frequency of good outcome (67% vs. 49%, p = 0.046).

Conclusion: Diabetes might be a risk factor of incomplete recanalization at 24 h regardless of early recanalization.     

急性脑梗死患者经神经节苷脂治疗的临床疗效

〔摘 要〕 目的：研究神经节苷脂治疗急性脑梗死患者的临床疗效。方法：选取漯河市第二人民医院 2019 年 8 月 至 2021 年 8 月期间收治 146 例的急性脑梗死患者，根据治疗方法不同分为观察组（78 例，神经节苷脂联合阿替普酶 治疗）和对照组（68 例，阿替普酶治疗）。比较两组患者的临床疗效，不同时期神经功能以及治疗前后炎症因子水平。 结果：观察组患者治疗总有效率为 91.67 %，高于对照组的 80.00 %，差异具有统计学意义（P ＜ 0.05）。两组患者治 疗后全血黏度、血浆黏度、红细胞比容及红细胞聚集指数均显著降低，且治疗后观察组患者的全血黏度、血浆黏度、 红细胞比容及红细胞聚集指数水平均显著低于对照组，差异具有统计学意义（P ＜ 0.05）。治疗后两组患者的 C 反应 蛋白（CRP）、肿瘤坏死因子 –α（TNF–α）水平均有明显的下降，而治疗后观察组患者的 CRP、TNF–α 水平均明显 低于对照组，差异具有统计学意义（P ＜ 0.05）。治疗 1 周后、治疗 2 周后两组患者的美国国立卫生研究院卒中量表 （NIHSS）评分均有明显的下降，而治疗 1 周后、治疗 2 周后观察组患者的 NIHSS 评分显著低于对照组，差异具有 统计学意义（P ＜ 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P ＞ 0.05）。结论：神经节苷脂联合 阿替普酶静脉溶栓治疗更有利于改善急性脑梗死患者的神经功能、血液流变学指标，且较单独使用阿替普酶治疗者可 更好的抑制患者炎症反应。     

支架取栓术治疗急性缺血性脑卒中的 效果及不良事件发生率分析

〔摘 要〕 目的：探讨支架取栓术用于急性缺血性脑卒中患者治疗的效果及不良事件发生率。方法：2021 年 3 月 至 2022 年 5 月取南阳市中心医院收治的 110 例急性缺血性脑卒中患者作为研究对象，以计算机随机化方法分组，分 为对照组与观察组两组，各 55 例，对照组为静脉溶栓方案，观察组为支架取栓术方案，比较两组患者治疗后血管再 通情况、神经功能缺损程度、预后情况、不良事件发生情况。结果： 两组患者血管再通率、预后良好率相比，观察组 均高于对照组，差异均具有统计学意义（P ＜ 0.05）；治疗后，两组患者的美国国立卫生研究院脑卒中量表（NIHSS） 评分均低于治疗前，且观察组患者治疗后的 NIHSS 评分较对照组更低，差异均具有统计学意义（P ＜ 0.05）；观察 组患者不良事件发生率为 9.09 %，较对照组的 23.64 % 更低，差异具有统计学意义（P ＜ 0.05）。结论：急性缺血性 脑卒中者以支架取栓术方案治疗，相比于静脉溶栓方案，能提高血管再通率、预后良好率，以及能更好地改善神经功 能缺损程度，降低不良事件的发生率。     

Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset

ObjectivesPatients waking up with stroke symptoms are often excluded from intravenous thrombolysis with alteplase (IV-tpa). The WAKE-UP trial, a European multicenter randomized controlled trial, proved the clinical effectiveness of magnetic resonance imaging-guided IV-tpa for these patients. This analysis aimed to assess the cost-effectiveness of the intervention compared to placebo.MethodsA Markov model was designed to analyze the cost-effectiveness over a 25-year time horizon. The model consisted of an inpatient acute care phase and a rest-of-life phase. Health states were defined by the modified Rankin Scale (mRS). Initial transition probabilities to mRS scores were based on WAKE-UP data and health state utilities on literature search. Costs were based on data from the University Medical Center Hamburg-Eppendorf, literature, and expert opinion. Incremental costs and effects over the patients’ lifetime were estimated. The analysis was conducted from a formal German healthcare perspective. Univariate and probabilistic sensitivity analyses were performed.ResultsTreatment with IV-tpa resulted in cost savings of €51 009 and 1.30 incremental gains in quality-adjusted life-years at a 5% discount rate. Univariate sensitivity analysis revealed incremental cost-effectiveness ratio being sensitive to the relative risk of favorable outcome on mRS for placebo patients after stroke, the costs of long-term care for patients with mRS 4, and patient age at initial stroke event. In all cases, IV-tpa remained cost-effective. Probabilistic sensitivity analysis proved IV-tpa cost-effective in >95% of the simulations results.ConclusionsMagnetic resonance imaging-guided IV-tpa compared to placebo is cost-effective in patients with ischemic stroke with unknown time of onset.     

急性闭塞性脑梗死介入溶栓术的护理观察

目的分析急性闭塞性脑梗死介入溶栓术的护理效果。方法运用随机抽样的方法选择治疗的急性闭塞性脑梗死患者100例,随机分为观察组和对照组各50例,对照组给予常规护理,观察组则在常规护理的基础上给予整体护理,比较2组患者的临床疗效、生活质量评分、并发症发生情况及患者满意度。结果对照组有效率为76.0%,观察组96.0%,观察组明显高于对照组,差异有统计学意义(P0.05);2组患者的生活质量评分均有所提高,且观察组生活质量改善程度明显高于对照组,差异均有统计学意义(均P0.05);对照组并发症发生率为12.0%,护理满意度为74.0%,观察组则分别为2.0%和94.0%,与对照组相比,观察组并发症发生率明显降低,护理满意度明显提高,差异均有统计学意义(P0.05)。结论在常规护理的基础上给予整体护理,能够有效提高介入溶栓术治疗急性闭塞性脑梗死的临床效果,有效降低并发症发生率,提高患者生活质量和满意度,可以在临床上推广应用。     

脑梗死超早期动脉溶栓后证候演变观察

目的探讨急性脑梗死超早期动脉溶栓后中医证候的演变。方法采用前瞻、对照方法,分析40例超早期脑梗死动脉溶栓后中医证候的动态演变。结果治疗14 d后,34例风证全部消失,气虚证由治疗前的0例变为8例,火证由治疗前的22例变为9例。瘀证在治疗前后的出现频率均为100%。急性脑梗死在超早期以实证为主,随着病程的发展,风证逐渐消失,实证的比例下降。而虚证,特别是气虚证的比例开始增加,瘀证在整个过程中则一直存在。治疗组证候的变化与保守治疗组没有明显差别。结论溶栓治疗对脑梗死超早期的证候演变没有产生明显的影响,治疗组的证候变化符合急性脑梗死超早期的总体证候演变规律。