| Objective: Traditional Chinese medicine has unique advantages in the treatment of cerebral infarction.Traditional Chinese medicine for promoting blood circulation and removing blood stasis is the most widely used drug in the acute phase,and the clinical effect of combined intravenous thrombolysis is obvious.However,it is not clear when the application of blood-activating and stasis-resolving drugs after thrombolysis is the best,and whether early intervention increases the risk of bleeding.In this study,patients with acute ischemic stroke treated by intravenous thrombolysis and differentiated as blood stasis blocking collaterals by traditional Chinese medicine were included.The changes of neurological deficit score,neurological outcome and adverse reactions were observed within 12 hours,12-24 hours and 24 hours after intravenous thrombolysis.To provide reference for the application of traditional Chinese medicine and the optimization of treatment plan after thrombolysis.Methods: A retrospective cohort study was conducted.From January2020 to December 2022,84 patients with acute ischemic stroke(blood stasis syndrome)who were hospitalized in our hospital and treated with intravenous rt-PA thrombolysis and combined with traditional Chinese medicine for promoting blood circulation and removing blood stasis after thrombolysis were included.According to the time node of using traditional Chinese medicine for promoting blood circulation and removing blood stasis after thrombolysis,they were divided into three groups : 12 h,12-24 h and >24h.The relevant baseline clinical data of the three groups were recorded.The NIHSS scores of each patient before thrombolysis,1 day and 7 days after thrombolysis and the m RS scores of 90 days after treatment were retrospectively observed.The improvement of neurological deficits and long-term neurological outcomes were evaluated.The changes of relevant laboratory indicators were analyzed.At the same time,the occurrence of adverse reactions such as bleeding complications was observed and recorded to evaluate the effectiveness and safety of treatment.SPSS25.0 statistical software was used for data analysis.Results:(1)During the 7-day observation period,the NIHSS scores before and after treatment were compared : the NIHSS scores of the 12 h group and the 12-24 h group before and after thrombolysis were significantly different(p<0.05).The NIHSS scores of the three groups before and 7 days after thrombolysis were significantly different(P<0.05).(2)Changes in early(24h)neurological deficits : Early neurological deterioration events,1 case(3.8%)in the 12 h group,1 case(4%)in the12-24 h group,and 7 cases(21.2%)in the > 24 h group.The overall difference in the early neurological deterioration rate between the three groups was statistically significant(P=0.044).There were 8 cases(30.8%)in the 12 h group,4 cases(16%)in the 12-24 h group,and 3 cases(9.1%)in the >24h group.The 12 h group had a tendency to improve early neurological deficits compared with >24h,but there was no significant difference between the three groups(P=0.093).(3)In terms of total clinical effective rate,the total effective rate of 12 h group was 88.5%,the total effective rate of 12-24 h group was 96%,and the total effective rate of > 24 h group was 90.9%.There was no significant difference between the three groups(p= 0.704).(4)Comparison of m RS scores before and after treatment,the difference of m RS score before and after treatment was statistically significant(P<0.001).The proportion of good functional outcomes at 90 days was96.2 % in the 12 h group,88 % in the 12-24 h group,and 84.8 % in the > 24 h group.There was no significant difference in good functional outcomes at 90 days among the three groups(P=0.367).(5)There was no intracranial hemorrhage in the 12 h group,1 case(4%)in the 12-24 h group,and 2 cases(6.1%)in the > 24 h group.There was no significant difference between the three groups(p = 0.456).There were 3cases(11.5%)in the 12 h group,4 cases(16%)in the 12-24 h group,and 4cases(12.1%)in the > 24 h group.There was no significant difference in the incidence of bleeding adverse events among the three groups(p=0.371).(6)In terms of laboratory indicators,there was no significant difference in PT,APTT,FIB,MPV,PLT,WBC and NLR between the three groups before and after treatment(P>0.05).In the same group before and after treatment,the neutrophil/lymphocyte ratio decreased significantly after treatment in the 12 h group and the 12-24 h group,and there was statistical significance before and after treatment(P<0.05).Conclusions:(1)rt-PA intravenous thrombolysis combined with traditional Chinese medicine for promoting blood circulation and removing blood stasis in the early 24 hours after treatment of acute ischemic stroke patients with blood stasis syndrome can effectively reduce the risk of early neurological deterioration,and the safety is good.(2)rt-PA combined with traditional Chinese medicine for promoting blood circulation and removing blood stasis in the treatment of acute ischemic stroke patients with blood stasis syndrome within 12 hours after intravenous thrombolysis has a tendency to promote early neurological recovery and improve long-term neurological outcome. |
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