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目的探讨静脉溶栓与侧支循环建立的序贯治疗在急性脑梗死(ACI)患者中的应用效果。方法符合溶栓指征的ACI患者155例分为三组:A组52例,静脉溶栓和人尿激肽原酶序贯治疗;B组42例,静脉溶栓治疗;C组61例,人尿激肽原酶治疗。治疗时间均为21d。比较治疗前、后美国国立卫生院神经功能缺损评分(NIHSS)和日常生活能力评分(Barthel指数)变化。应用经颅多普勒超声评估颅内大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)血流速度。结果与治疗前比较,三组患者治疗后NIHSS下降、Barthel指数提高(P<0.05);A组改善大于B、C组(P<0.01)。A组总有效率高于B、C组(P<0.05)。三组患侧ACA、MCA、PCA血流速度均较治疗前增快(P<0.05);A组治疗后患侧各动脉血流速度较B、C组快(P<0.05)。结论与单用静脉溶栓或人尿激肽原酶治疗比较,静脉溶栓和人尿激肽原酶序贯治疗更能有效改善ACI患者的神经功能缺损。
Objective To investigate the effect of sequential therapy of venous thrombolysis and collateral circulation in patients with acute cerebral infarction (ACI). Methods Fifty-five patients with ACI who were eligible for thrombolytic therapy were divided into three groups: group A (n = 52), sequential intravenous thrombolysis and human urokinase; group B (n = 42) received intravenous thrombolysis; group C Human urokinase therapy. The treatment time is 21d. The changes of NIHSS and Barthel index of the National Institutes of Health before and after treatment were compared. Transcranial Doppler echocardiography was used to assess intracranial cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) blood flow velocity. Results Compared with those before treatment, NIHSS decreased and Barthel index increased (P <0.05). A group improved more than B, C group (P <0.01). The total effective rate of group A was higher than that of group B and C (P <0.05). The blood flow velocity of ACA, MCA and PCA in the three groups were faster than that before treatment (P <0.05). The blood flow velocity of each artery in group A was faster than that in group B and C (P <0.05). Conclusion Compared with the single intravenous thrombolysis or human urokinase treatment, sequential intravenous thrombolysis and human kallikrein treatment is more effective in improving neurological deficits in ACI patients.