注射用重组人尿激酶原溶栓治疗老年急性脑梗死的临床疗效及其对神经功能和生活质量的影响

摘要

目的 探讨注射用重组人尿激酶原(rh-proUK)溶栓治疗老年急性脑梗死的临床疗效及其对神经功能和生活质量的影响.方法 将120例老年急性脑梗死患者依据治疗方案及rh-proUK使用剂量分为高剂量组、低剂量组及对照组,每组40例,入院后均进行内科常规治疗,对照组同时给予(rt-PA),高剂量组给予rh-proUK 50 mg,低剂量组给予rh-proUK 35 mg.检测三组治疗前及溶栓后24 h血流动力学、神经功能相关因子水平,于治疗后3个月行神经功能及生活质量评分.结果 治疗后,三组Vmean、Vmax、Vmin、Qmean均升高,R、GFAP、S-100B、NSE、MBP降低(P＜0.05或P＜0.01);与对照组比较,高、低剂量组Vmean、Vmax、Vmin、Qmean均升高,R、GFAP、S-100B、NSE、MBP降低(P＜0.05或P＜0.01);与低剂量组比较,高剂量组Vmin升高,R降低(P＜0.05或P＜0.01);高、低剂量组各项神经功能因子比较差异无统计学意义(P＞0.05).治疗后3个月,与对照组比较,高、低剂量组Barthel指数、SF-36评分升高,NIHSS评分降低(P＜0.05或P＜0.01),三组间MMSE评分比较差异无统计学意义(P＞0.05);高、低剂量组各神经功能评分、SF-36评分比匕较差异无统计学意义(P＞0.05).结论 注射用重组人尿激酶原治疗老年急性脑梗死疗效确切,可迅速溶解血栓、恢复脑组织灌注,促进机体神经功能的恢复,改善患者预后,同时低剂量即可维持较好的治疗效果.%Objective To discuss the clinical efficacy of rh-proUK in the treatment of senile patients with acute cerebral infarction and its effects on neurological function and quality of life.Methods Totally 120 elderly patients with acute cerebral infarction were divided into high-dose group,low-dose group and control group according to the treatment strategy and the dose of rh-proUK,40 cases in each group.All the patients were given routine medical treatment after admission;patients in high-dose group and low-dose group were given 50 mg and 35 mg of rh-proUK respectively,while patients in control group were given rt-PA at the same time.The hemodynamic and neurological function-related factors were measured before and at 24 h after thrombolysis,then the neurological function and scores of quality of life were evaluated at 3 months after treatment.Results After treatment,the levels of Vmean,Vmax,Vmin and Qmean of patients were increased significantly,while the level of R,GFAP,S-100B,NSE and MBP were decreased significantly (P ＜ 0.05 or P ＜ 0.01);the level of Vmean,Vmax,Vmin and Qean in high-dose and low-dose groups were higher than those of control group,while the levels of R,GFAP,S-100B,NSE and MBP were lower (P ＜0.05 or P ＜0.01);Vmin in high-dose group was higher than that of low-dose group,while the level of R was lower (P ＜ 0.05 or P ＜ 0.01).There was no significant difference in neurological factors between high-dose group and low-dose group (P＞ 0.05).At 3 months after treatment,Barthel index and SF-36 score in high-dose and low-dose groups were higher than those of control group,while the NIHSS score was lower (P ＜ 0.05 or P ＜ 0.01),but no significant difference was found in MMSE scores among the 3 groups (P ＞ 0.05);there was no significant difference in the neurological function score or SF-36 score between high-dose group and low-dose group (P ＞ 0.05).Conclusion The rh-proUK can quickly dissolve thrombus,restore cerebral perfusion,and promote the recovery of neurological function.It has definite effect on acute cerebral infarction in elderly patients and improve their prognosis.