局部亚低温联合rt-PA静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤及预后的影响

doi:10.3969/j.issn.1007-3205.2021.02.008

河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (2): 158-162.doi: 10.3969/j.issn.1007-3205.2021.02.008

局部亚低温联合rt-PA静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤及预后的影响

1.河北省秦皇岛市第一医院急诊科，河北秦皇岛 066000；2.河北省秦皇岛市中医医院脑病科，河北秦皇岛 066000

出版日期:2021-02-25 发布日期:2021-03-09
作者简介:张鑫宇（1982-），女，河北秦皇岛人，河北省秦皇岛市第一医院主治医师，医学硕士，从事急诊科疾病诊治研究。
基金资助:
秦皇岛市科学技术研究与发展计划项目（201703A050）

Effects of local mild hypothermia combined with RT PA intravenous thrombolysis on #br# oxidative stress, neurological damage and prognosis in patients with acute large area cerebral infarction

1.Department of Emergency, the First Hospital of Qinhuangdao, Hebei Province， Qinhuangdao
066000, China; 2.Department of Encephalopathy, the Traditional Chinese Medicine
Hospital of Qinhuangdao, Hebei Province， Qinhuangdao 066000, China

Online:2021-02-25 Published:2021-03-09

摘要/Abstract

摘要： 目的观察局部亚低温联合重组人组织型纤溶酶原激活剂（hemorrhage after recombinant human tissue-type plasminogen activator， rt-PA）静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤及预后的影响。
方法选取急性大面积脑梗死患者79例，根据治疗方法的不同分为观察组41例和对照组38例，对照组在对症基础治疗上给予rt-PA静脉溶栓治疗，观察组在对照组基础上联合亚低温治疗。比较2组治疗前及治疗后7 d超氧化物歧化酶（superoxide dismutase，SOD）、丙二醛（malondialdehyde，MDA）、心型脂肪酸结合蛋白（heart-type fatty acid binding protein,H-FABP）、N端前脑钠肽（N terminal pro B type natriuretic peptide,NT-proBNP）、神经元特异性烯醇化酶（neuron-specific enolase，NSE）、S100β蛋白水平、神经功能缺损［美国国立卫生研究院卒中量表（NIH stroke scale,NIHSS）评分］及日常活动能力恢复情况［Barthel指数（barthel index，BI）］，比较不良反应发生情况。
结果治疗后，2组SOD高于治疗前，MDA低于治疗前，观察组SOD高于对照组，MDA低对照组，差异有统计学意义（P＜0.01）。2组H-FABP、NT-proBNP、NSE及S100β水平均低于治疗前，观察组H-FABP、NT-proBNP、NSE及S100β水平低于对照组，差异有统计学意义（P＜0.01）。2组NIHSS评分低于治疗前，BI高于治疗前，观察组NIHSS评分低于对照组，BI高于对照组，差异均有统计学意义（P＜0.01）。2组治疗7 d内总不良反应发生率比较差异无统计学意义（P＞0.05）。
结论局部亚低温联合rt-PA静脉溶栓治疗急性大面积脑梗死可显著减轻氧化应激反应、脑神经损伤程度，降低相关神经损伤因子水平，改善预后。

关键词: 脑梗死, 亚低温, 静脉溶栓

Abstract: Objective To observe the effect of local mild hypothermia combined with recombinant human tissue type plasminogen activator(rt-PA) intravenous thrombolysis on oxidative stress, neurological damage and prognosis in patients with acute massive cerebral infarction.
Methods A total of 79 patients with acute large area cerebral infarction were divided into the observation group(41 cases) and the control group(38 cases). The control group was treated with rt-PA intravenous thrombolysis on the basis of symptomatic treatment, and the observation group was treated with mild hypothermia on the basis of the control group. The superoxide dismutase(SOD), malondialdehyde(MDA), heart type fatty acid binding protein(H-FABP), N-terminal pro-B type natriuretic peptide(NT-proBNP) between two groups before and 7 days after treatment were compared. The levels of NT proBNP, neuron specific enolase(NSE), S100β protein, and NIH stroke scale(NIHSS) score and recovery of daily activities［barthel index(BI)］, the incidence of adverse reactions were compared.
Results After treatment, SOD in two groups was higher than that before treatment, MDA was lower than that before treatment, SOD in observation group was higher than that in control group and MDA was lower in control group, the difference was statistically significant(P＜0.01). The levels of H-FABP, NT-proBNP, NSE and S100β in the two groups were lower than those before treatment, while the levels of H-FABP, NT-proBNP, NSE and S100β in the observation group were lower than those in the control group(P＜0.01). NIHSS score of two groups was lower than that before treatment, BI was higher than before treatment, NIHSS score of observation group was lower than that of control group, BI was higher than that of control group, the differences were statistically significant(P＜0.01). There was no significant difference in the incidence of adverse reactions between two groups within 7 days(P＞0.05).
Conclusion Iocal mild hypothermia combined with rt-PA intravenous thrombolysis can significantly improve the clinical effect of acute large area cerebral infarction, reduce the degree of oxidative stress and brain nerve injury, reduce the level of related nerve injury factors, and improve the prognosis of patients.

Key words: brain infarction； mild hypothermia, intravenous thrombolysis

张鑫宇, 赵鑫, 张重阳, 王耀辉, 刘宇鹏. 局部亚低温联合rt-PA静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤及预后的影响[J]. 河北医科大学学报, 2021, 42(2): 158-162.

ZHANG Xin-yu, ZHAO Xin, ZHANG Chong-yang, WANG Yao-hui, LIU Yu-peng. Effects of local mild hypothermia combined with RT PA intravenous thrombolysis on #br# oxidative stress, neurological damage and prognosis in patients with acute large area cerebral infarction[J]. Journal of Hebei Medical University, 2021, 42(2): 158-162.

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局部亚低温联合rt-PA静脉溶栓治疗对急性大面积脑梗死患者氧化应激、神经功能损伤及预后的影响

Effects of local mild hypothermia combined with RT PA intravenous thrombolysis on #br# oxidative stress, neurological damage and prognosis in patients with acute large area cerebral infarction

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