亚低温联合静脉溶栓促进急性脑梗死患者神经功能恢复的临床研究

摘要

Objective:To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction.Methods:176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group(n=100 cases,receiving routine intravenous thrombolysis therapy)and the mild hypothermia group(n=76,receiving mild hypother-mia + intravenous thrombolysis therapy),and the treatment lasted for 1 week.The differences in serum levels of nerve injury indexes,inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment.Results:Before treatment,there was no statistically significant difference in serum levels of nerve injury in-dexes,inflammatory mediators and neurotransmitters between the two groups.After 1 week of treatment,serum nerve injury indexes H-FABP,NT-proBNP,NSE and S100B levels of mild hypothermia group were lower than those of routine group;in-flammatory mediators sICAM-1,IL-8,IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group.Conclusion:mild hypo-thermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response,and optimize the neurotransmitter distribution in patients with acute cerebral infarction.%目的:探讨亚低温+静脉溶栓促进急性脑梗死患者神经功能恢复的效果.方法:选择2015年9月~2017年2月在本院接受治疗的急性脑梗死患者176例,回顾治疗方案,并将入组患者分为常规组(n=100,接受常规静脉溶栓治疗)、亚低温组(n=76,接受亚低温+静脉溶栓治疗),持续治疗1周.对比两组患者治疗前、治疗1周后血清中神经损伤指标、炎症介质、神经递质含量的差异.结果:治疗前,两组患者血清中神经损伤指标、炎症介质、神经递质含量的差异无统计学意义(P>0.05).治疗1周后,亚低温组患者血清中神经损伤指标心型脂肪酸结合蛋白(H-FABP)、N端前脑钠肽(NT-proBNP)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)含量低于常规组;炎症介质可溶性细胞间黏附分子-1(sICAM-1)、白介素(IL)-8、IL-13、IL-18的含量低于常规组;神经递质谷氨酸(Glu)含量低于常规组,γ氨基丁酸(GABA)含量高于常规组.差异均有统计学意义(P<0.05).结论:急性脑梗死患者接受亚低温+静脉溶栓治疗,可有效减轻神经损伤及全身炎症反应,优化神经递质分布.