支架取栓联合奥扎格雷钠治疗急性重型血栓性脑卒中的效果及对患者认知功能的影响

摘要

目的 探讨支架取栓联合奥扎格雷钠治疗急性重型血栓性脑卒中患者的临床效果及对患者认知功能的影响.方法 选择急性重型血栓性脑卒中患者90例,随机分为对照组和联合治疗组各45例.两组患者均给予常规治疗,对照组同时给予奥扎格雷钠治疗,联合治疗组同时给予奥扎格雷钠联合支架取栓治疗.比较两组患者治疗前后的血小板黏附试验(PAdT)及血小板聚集试验(PAgT)结果、血小板CD62p和血小板P选择素水平;采用美国国立卫生研究院脑卒中量表(NIHSS)和格拉斯哥昏迷量表(GCS)评估患者治疗前后症状改善情况;采用事件相关电位测试、眼动测试评定患者治疗前后认知功能水平;记录两组治疗后颅内出血、呼吸衰竭、肺部感染发生情况.结果 治疗后,联合治疗组PAdT及PAgT结果、CD62p及P选择素水平、NIHSS评分低于治疗前水平及对照组,GCS高于治疗前水平及对照组(P<0. 05).治疗后联合治疗组电位P300的潜伏期和波幅及眼动凝视点数均低于治疗前水平及对照组,反应性探索评分高于治疗前水平及对照组(P<0. 05);联合治疗组颅内出血、呼吸衰竭、肺部感染的发生率均低于对照组(均P<0. 05).结论 与单纯奥扎格雷钠治疗比较,支架取栓联合奥扎格雷钠治疗急性重型血栓性脑卒中可更好地改善患者血小板功能,提高认知功能.%Objective To explore the clinical efficacy of stent-retriever thrombectomy combined with ozagrel sodium for acute severe thrombotic stroke and its effect on the patients′ cognitive function. Methods Ninety patients with severe thrombotic stroke were enrolled and were randomly divided into control group(n=45) and combined therapy group(n=45). The two groups were treated with conventional therapy,besides,the control group was treated with ozagrel sodium,while the combined therapy group received ozagrel sodium and stent-retriever thrombectomy. The results of platelet adhesion test(PAdT) and platelet aggregation test(PAgT) before and after treatment,as well as the levels of platelet CD62p and platelet P-selectin were compared between the two groups. The National Institutes of Health Stroke Scale(NIHSS) and Glasgow Coma Scale(GCS) were used to evaluate the symptom improvement of the patients after treatment,and the event-related potential test and eye movement test to assess the cognitive function of the patients before and after treatment. The incidence of intracranial hemorrhage,respiratory failure and pulmonary infection after treatment were recorded in the two groups. Results After treatment, the levels of PAdT,PAgT,CD62p,P-selectin and NIHSS score were lower while the GCS score was higher in the combined therapy group than those before treatment or in the control group(all P<0. 05). After treatment,the latency and amplitude of potential P300 as well as number of eye fixation(NEF) in eye movement test were lower but reactive search score(RSS) was higher in the combined therapy group compared to those before treatment or in the control group(all P<0. 05). The incidence rates of intracranial hemorrhage,respiratory failure and pulmonary infection in the combined therapy group were lower than those in the control group(all P< 0. 05). Conclusion Compared to monotherapy of ozagrel sodium,stent-retriever thrombectomy combined with ozagrel sodium can better improve platelet function and cognitive function in the treatment of acute severe thrombotic stroke.