瑞替普酶对老年脑梗死患者的治疗效果

Efficacy and safety of reteplase in treatment of elderly patients with cerebral infarction

摘要:

目的 探讨瑞替普酶治疗老年脑梗死的疗效及安全性。方法 收集2018年9月至2019年3月我院收治的老年脑梗死患者64例。研究组给予瑞替普酶治疗,对照组采用阿替普酶治疗。记录2组患者治疗后美国国立卫生研究院的卒中量表(NIHSS)评分变化和不良反应的发生情况。随访患者3个月,采用改良Rankin量表(MRS)评分衡量患者的神经功能恢复状况,并分析生存情况。采用ELISA法测定2组患者治疗前后血浆中超氧化物歧化酶(SOD)和丙二醛(MDA)含量。采用SPSS 20.0软件进行数据分析,两组间比较采用t/χ²检验,生存分析采用Kaplan-Meier法并行Log-rank检验。结果 研究组患者在治疗3、7、30d后NIHSS评分均低于对照组(P<0.05)；研究组治疗总有效率高于对照组[93.55%(29/31)和77.78%(21/27)；χ²=10.631,P=0.001]。治疗3个月后,研究组中达到无明显残障水平患者数量显著多于对照组[62.5%(20/32)和43.75%(14/32)；χ²=6.816,P=0.009]。研究组患者3个月生存率高于对照组(P<0.05)。2组患者均有出血症状不良反应出现,但其不良事件发生率差异无统计学意义(P>0.05)。2组患者治疗后的MDA浓度较溶栓前降低(P<0.05),SOD浓度较溶栓前增高(P<0.05)。溶栓后,研究组与对照组相比, SOD升高(P<0.05),MDA降低(P<0.05)。结论 瑞替普酶治疗可改善老年脑梗死患者预后,不良反应发生率低,其机制可能与减轻患者氧化应激反应有关。

Abstract:

Objective To investigate the clinical efficacy of reteplase in the treatment of elderly patients with cerebral infarction. Methods A total of 64 elderly patients with cerebral infarction from September 2018 to March 2019 were randomly divided into study group and control group. The study group were treated with reteplase, and the control group with alteplase. After the treatment, the two groups were evaluated using National Institute of Health Stroke Scale (NIHSS), and adverse reactions were recorded. The recovery of the patients′ neurological function was measured by the modified Rankin scale (MRS), and survival rate was analyzed during three months of follow-up. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) were assessed by ELISA before and after thrombolytic therapy. The data were statistically analyzed by SPSS statistics 20.0. The comparison between the two groups was performed by t/χ² test. Survival analysis was estimated by Kaplan-Meier method and tested by Log-rank test. Results NIHSS score was lower in study group than in the control group (P<0.05) at 3d, 7d, 30 d of thrombolysis, and the overall effective rate was higher in the former than in the latter [(93.55%(29/31) vs 77.78%(21/27);χ²=10.631, P=0.001]. After 3 months of treatment, no obvious disability was observed in 62.5%(20/32) of the study group, which was significantly higher than 43.75%(14/32) of the control group (χ²=6.816, P=0.009). The 3-month survival rate of the study group was higher than that of the control group (P<0.05). Adverse reactions such as bleeding occurred in both groups, but with no significant difference between the two groups (P>0.05). Compared with before treatment, SOD significantly increased and MDA significantly decreased (P<0.05) in both groups after treatment. SOD increased more significantly and MDA decreased more significantly in the study group than in the control group (P<0.05). Conclusion Reteplase treatment can improve the prognosis of patients with cerebral infarction without increasing the incidence of adverse reactions, and its mechanism may be related to inhibition of oxidative stress reaction.