盘爱花,李其富,邝小玲,陈永敏
PAN Aihua,LI Qifu,KUANG Xiaoling,CHEN Yongmin

• 1:海南医学院第一附属医院神经内科二病区

摘要(Abstract)：

目的:探讨血压监测及降压干预对急性脑梗死静脉溶栓患者预后的影响。方法:90例急性脑梗死患者均分为对照组与观察组,对照组患者常规溶栓及营养等治疗,观察组在对照组患者治疗的基础上给予血压监测及降压干预,2组患者均随访3个月;比较2组患者治疗前及治疗第7天时血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平,于治疗前及治疗后第1、3及5天时,采用美国国立卫生研究院卒中量表(NIHSS)评分评估2组患者的神经功能;治疗后第30天时,采用改良Rankin量表(mRS)评分评估2组患者的神经功能恢复情况,比较随访期间2组患者的出血发生率。结果:治疗前,2组患者血清IL-6、IL-8、TNF-α水平及NIHSS评分比较,差异无统计学意义(P> 0. 05); 2组患者治疗第7天时血清IL-6、IL-8及TNF-α水平均较治疗前降低,观察组低于对照组,差异有统计学意义(P <0. 05); 2组患者治疗后各时间点NIHSS评分较治疗前降低,观察组低于同时点对照组,差异有统计学意义(P <0. 05);治疗后第30天时,观察组患者mRS评分中轻度残障人数高于对照组、重度残障人数低于对照组,差异有统计学意义(P <0. 05); 2组患者治疗期间的出血发生率比较,差异无统计学意义(P> 0. 05)。结论:血压监测及降压干预可改善急性脑梗死患者静脉溶栓后NIHSS及mRS评分。
Objective: To investigate the effects of blood pressure monitoring and intervention on the prognosis of patients with acute cerebral infarction undergoing intravenous thrombolysis. Methods: 90 patients with acute cerebral infarction were selected and divided into control group and observation group with equal number. Both groups were treated with intravenous thrombolysis and nutrition therapy,and observation group was given extra blood pressure monitoring and lowering blood pressure intervention; both groups were followed up for 3 months after treatment. Interleukin-6( IL-6),interleukin-8( IL-8) and tumor necrosis factor-α( TNF-α) were compared before and after treatment( 7 days) in both groups. National Institutes of Health Stroke Scale( NIHSS) was used to assess the neurological function before treatment and on the 1 st,3 rd,5 thday after treatment; modified Rankin scale( mRS) was adopted to evaluate the neurological function recovery on the 30 th day after treatment,and the incidence rate of bleeding during follow-up was compared. Results: The levels of IL-6,IL-8 and TNF-α as well as NIHSS scores of both groups before treatment showed no statistical significance( P > 0. 05). On the 7 thday of treatment,levels of IL-6,IL-8 and TNF-α of both groups were obviously lowered than before treatment,observation group was significantly lower than control group,differences were statistically significant( P < 0. 05). NIHSS scores of both groups at all recorded time were lower than before treatment,observation group scores were obviously lower than control group at each same recorded time,differences were statistically significant( P < 0. 05); 30 days after treatment,mRS scores of observation showed that number of mildly disabled people were obviously higher than that of control group,number of severely disabled people were obviously lower than that of control group,differences were statistically significant( P < 0. 05). Comparison of bleeding incidence rate of both groups during treatment showed that differences were not statistically significant( P > 0. 05). Conclusion: Blood pressure monitoring and intervention can improve the NIHSS score and mRS score of patients with acute cerebral infarction undergoing intravenous thrombolysis.

关键词(KeyWords)： 血压;白细胞介素类;预后;急性脑梗死;静脉溶栓;神经功能
blood pressure;interleukins;prognosis;acute cerebral infarction;intravenous thrombolysis;neurological function

Abstract:

Keywords:

基金项目(Foundation): 海南省卫生和计划生育委员会卫生计生行业科研课题(18A200120)

作者(Author): 盘爱花,李其富,邝小玲,陈永敏
PAN Aihua,LI Qifu,KUANG Xiaoling,CHEN Yongmin

DOI: 10.19367/j.cnki.2096-8388.2020.09.016

参考文献(References)：

• [1]NAI Y,LIU H,BI X,et al. Protective effect of astaxanthin on acute cerebral infarction in rats[J]. Hum Exp Toxicol,2018,37(9):929-936.
• [2]ZHANG Y N,GUO Z N,ZHOU H W,et al. Fabry disease with acute cerebral infarction onset in a young patient[J]. Chinese Med J,2019,132(4):477-479.
• [3]南宇飞，卢翠莲，严之红．合并H型高血压的急性脑梗死患者血压变异性及其临床意义[J]．中国医学装备，2018,15(1):78-81.
• [4]牛兆．阿替普酶静脉溶栓治疗急性脑梗死24例临床疗效分析[J]．中国药物与临床，2020,20(10):1676-1678.
• [5]陶丹，何鑫，汪燕云．H型高血压伴急性脑梗死患者外周血HCY与LP-PLA2、RDW、UA变化及相关性分析[J]．中风与神经疾病杂志，2020,37(4):298-301.
• [6]王国瑜，汪洋，石华，等．脑白质疏松与急性脑梗死患者认知功能的关系研究[J]．实用心脑肺血管病杂志，2020,28(5):23-26.
• [7]刘磊，冯浩，杨兴东，等．急性脑梗死发病危险因素分析[J]．山东医药，2020,60(12):85-87.
• [8]魏俊，杨珉，王威．亚低温联合阿替普酶对急性脑梗死患者脑血流和神经功能恢复的影响[J]．东南国防医药，2020,22(3):254-257.
• [9]尤晓涵，杨淼，明霞光，等．盐酸川芎嗪注射液联合丁苯酞软胶囊治疗急性脑梗死疗效及对患者血液流变学影响[J]．陕西中医，2020,41(6):743-745,757.
• [10]刘雯，陈国芳，梁艺馨，等．脑白质病变对急性脑梗死rt-PA静脉溶栓患者临床预后及出血转化的影响[J]．神经损伤与功能重建，2020,15(5):281-284.
• [11]宋道辉，席春华，穆燕芳，等．血压变异性与急性脑梗死患者预后的相关性分析[J]．中国医药导报，2020,17(11):65-68.
• [12]刘李军，何玮．脑梗死急性期血压变异性与认知功能障碍的相关性分析[J]．河北医药，2019,41(3):442-444.
• [13]李宇，王青银，桑泽东，等．动脉粥样硬化型急性脑梗死病人脑血管反应性的应用价值[J]．中西医结合心脑血管病杂志，2020,18(8):1308-1311.
• [14]刘春苗，杨国帅，钟伟，等．H型高血压合并脑梗死患者ALDH2基因多态性与Hcy代谢、炎性反应及氧化应激状态的相关性[J]．疑难病杂志，2019,18(6):554-558.
• [15]马妮娜，白晓黎．丁苯酞氯化钠注射液联合鼠神经生长因子治疗急性脑梗死的疗效及对炎症因子水平的影响[J]．西北药学杂志，2019,34(5):670-672.
• [16]余波，沈宇斐，陆旭东，等．急性脑梗死患者并发肺部感染的危险因素及与IL-6基因-572C/G基因多态性相关性分析[J]．中华医院感染学杂志，2020,30(7):999-1002.
• [17]张贵臣．脑梗死患者血清hs-CRP、IL-17、IL-6水平及与NIHSS评分的相关性[J]．检验医学与临床，2020,17(6):834-837.
• [18]韩丽丽，项蓉，刘万根，等．Solitaire AB支架取栓术联合替罗非班和丁苯酞对急性脑梗死患者神经功能和炎性因子的影响[J]．中国临床研究，2020,33(4):488-492.
• [19]黄丹华，孙达．依达拉奉对急性脑梗死患者炎症因子的影响[J]．医学综述，2019,25(23):4808-4811.
• [20]高元杰，钟纯正，欧诒丹．脑梗死合并肺部感染患者TNF-α、HMGBl、TLR4-NF-κB信号通路改变研究[J]．中华医院感染学杂志，2020,30(7):1003-1006.
• [21]孔令宇，马文婷，杨亚勤，等．氯吡格雷联合瑞舒伐他汀对急性脑梗死患者血清炎性因子的影响[J]．广东医学，2020,41(2):130-133.
• [22]王利娜，费爱华．自拟平肝汤辅助西药治疗糖尿病合并脑梗死急性期临床疗效及对IL-6、TNF-α水平的影响[J]．中西医结合心脑血管病杂志，2019,17(24):4077-4080.
• [23]欧阳欣，胡巧霞，张昀赟，等．前列地尔联合阿托伐他汀治疗老年急性脑梗死伴颅内动脉狭窄的疗效及对血清炎性因子的影响[J]．中国老年学杂志，2019,39(22):5443-5445.
• [24]刘杨，吴功祥，杨静．丁苯酞联合依达拉奉对高血压脑出血患者脑血管功能及降钙素基因相关肽和沉默信息调节因子1水平的影响[J]．中国医药，2020,15(5):703-707.
• [25]关明子，王兆丰，刘一飞，等．肿瘤合并冠心病经皮冠状动脉介入治疗术后高血压患者临床特点及预后[J]．临床军医杂志，2020,(5):547-550,555.
• [26]于龙娟，张铭斐，王琴等．急性缺血性脑卒中静脉溶栓治疗后血压集束化管理对预后的影响[J]．第二军医大学学报，2018,39(9):1034-1039.

文章评论(Comment)：