阿替普酶联合鼠神经生长因子对溶栓时间窗外急性脑梗死的疗效

目的观察在溶栓时间窗外急性脑梗死患者使用阿替普酶联合鼠神经生长因子的临床疗效。方法选取60例在溶栓时间窗外的急性脑梗死患者,随机分为2组各30例,观察组使用阿替普酶针联合鼠神经生长因子治疗,对照组单用应用鼠神经生长因子治疗。分别在治疗前后14d行CTP检查,评估大脑中动脉(MCA)的峰流速(Vp)、平均流速(Vm)的变化情况,对比血清神经元特异性烯醇化酶水平及NIHSS评分。结果治疗后,观察组梗死中心脑血容量(CBV)和脑血流量(CBF)较治疗前增加,平均通过时间(MTT)缩短,改善程度较对照组高(P0.05)。观察组梗死灶周围CBV、CBF较前均增加(P0.05),优于对照组(P0.05)。观察组患者梗死中心、梗死周围的相对脑血容量(rCBV)和相对脑血流量(rCBF)均较前明显增加(P0.05),其中梗死灶周围rCBV的增加明显高于对照组(P0.05)。观察组Vp和Vm明显增高,血清NSE水平降低显著,NIHSS评分也降低明显(P0.05),且均优于对照组(P0.05)。结论在溶栓时间窗外急性脑梗死患者使用阿替普酶联合鼠神经生长因子治疗,能显著改善脑梗死中心及周围区域的组织灌注,且改善梗死周围区域组织灌注更明显,改善血流动力学,减轻脑神经损伤,促进神经功能的恢复。

Effect of alteplase combined with mouse nerve growth factor in the treatment of acute cerebral infarction outside thrombolysis time window

Objective To observe clinical efficacy of alteplase combined with mouse nerve growth factor in acute cerebral in-farction.Methods 60 patients with acute cerebral infarction were randomly divided into observation group (alteplase combined with mouse nerve growth factor)and control group (mouse nerve growth factor),with each group of 30 cases.(Vp)and mean flow velocity (Vm)in the middle cerebral artery (MCA)were measured before and after 14 days of treatment.The levels of serum neuron-specific enolase were measured and compared with those of NIHSS score.Results After treatment,the CBV and CBF of the infarcted center in the observation group were increased and the MTT was shorter than that before the control group (P <0.05).After treatment,the CBV and CBF in the infarcted area were significantly higher than those in the control group (P <0.05).After treatment,rCBV and rCBF were significantly increased (P <0.05),and the degree of rCBV was significantly higher in the observation group than in the control group (P <0.05).After treatment,Vp and Vm were significantly increased in the ob-servation group,serum NSE levels were significantly decreased,NIHSS score was significantly lower (P <0.05),and were better than the control group (P <0.05 ).Conclusion Acute cerebral infarction with thrombolytic therapy in combination with mouse nerve growth factor can improve the perfusion of infarct center and its surrounding area in patients with cerebral infarction,espe-cially in the infusion of infarcted tissue.At the same time,it can improve the hemodynamics,reduce nerve damage,and promote nerve function recovery.