Analysis Of Clinical Effect And Safety In Continuous Administration Through Arterial Indwelling Catheter For Acute Cerebral Infarction

OBJECTIVE：As one of the most common disease in neurology with higher morbiditymortality and recurrence rate, acute brain infarction has seriously affected our dailylife. At present,much research is consentrated on the drug treatment of brain infarction.Besides the reasonable collocation of drugs namely “cocktail therapy”, the approacha drug operates in the body and develops its effects should be more concerned.Patients mainly are given medication intravenously. Intravenous administration is aintradional route of administration which is convenient and simple with small trauma.The metabolism of the medicine is mainly through liver and kidney. But theexistence of Blood Brain Barrier(BBB) has seriously limited the drug consentration inthe brain parenchyma lesions. Medicine given through an artery can provide a higherdrug consentration in the lesions, higher bioavailability, induce the brain first passeffect(FPE) and reduce the side effects on the whole body, which is commonly calledarterial local administration. Arterial local administration as a therapy for braininfarction is mainly used in the superacute stage namely artery endovascularthrombolysis. There are lots of basic research and clinical reports about this approach.However study about continuous administration through arterial indwelling catheter inthe lesions to fibrinolysis, improve microcirculation and protect cerebral parenchymais barely reported. In the treatment of cerebral infarction, the routes of administrationdetermine whether the drug will get metabolized or distributed and has a directlyeffects on the terminal drug consentration in the target position which will finallyinfluence the bioavailability and clinical effects of the drug. In many basic and clinicalareas, people are trying to study different routes of local administration and therespective effect.This study included131patients suffered acute brain infarction who accepteddifferent therapies: arterial local administration once, continuous administrationthrough arterial indwelling catheter for3days,7days respectively. Through the comparison about neurological function recovery, relevant laboratory indicators(PLT、APTT、PT、FIB、BUN、CRE、ALT), inflammatory factor (TNF-α、IL-1β、hs-CRP) in different groups,we aimed to determine the safety and efficiency ofarterial administration and its influence on the inflammation, meanwhile to investigatethe best ways of administration and the concrete methods of treatment.Method:1. Clinical data all the patients were collected from the Jilin armed police corpshospital in the invasive technology department during2011-10-01~2013-03-01,diagnosed first occured acute internal carotid circulation infarction in12-72hours.They all accept same conention treatment (adjust blood pressure, blood glucose,blood lipid, take aspirin, nimodipine, appropriate application of20%mannitol forcerebral edema patients). All terms were given plasmin200u, ShuxueningInjection20ml, edaravone30mg everyday.2. Group of Experiments All the patients were devided into4groups:1)Controlgroup:32patients, intravenous administration;2)Treatment groupΙ:32patients,arterial administration (were given plasmin200u, Shuxuening Injection20ml,edaravone30mg) once in the early stage, subsequently intravenous administrationeveryday as control group;3)Treatment group II：35patients, continuousadministration through arterial indwelling catheter for3days and removed thecatheter,subsequently same as control group;4)Treatment group III:32patients,continuous administration through arterial indwelling catheter for7days andremoved the catheter,subsequently same as control group. The total course oftreatment was14days.3. Observation of curative effect Through the comparison about neurologicalfunction recovery of each group before and2weeks after treatment in patients,evaluate the clinical efficacy of the treatment.4. Safety observation During the treatment, general conditions of patients were dailyroutine monitored such as body temperature, heart rate, respiration, blood pressure.For the first days and14thdays those indexes were detected in patients includingPLT, APTT, PT, FIB, BUN, CRE, ALT and head MRI, electrocardiogram. Noticethe occurrence of adverse reaction.5. Inflammatory factor monitoring To evaluate the effects on inflammation in thebody of different therapies through the comparison of IL-1β、hs-CRP、TNF-α between the groups.RESULTS1. Through the comparison about neurological function recovery grades, thecurative effect in the treatment group I was better than control group, treatmentgroup II and III had similar grades, but both better than treatment group I.2. Relevant laboratory indicators (PLT、APTT、PT、FIB、BUN、CRE、ALT) in allgroups had no difference. However,2patients in treatment group II localdeveloped bleeding puncture site hematoma and accepted local pressurization,2patients occured fever and2bleeding puncture site hematoma in treatment groupIII, all received symptomatic treatment and no further therapy were conducted.Control group and treatment group I both had1patient whose condition worsened.3. Inflammatory factors level between treatment groups and control group hadstatistically significant difference (P<0.05). Inflammatory factors in the treatmentgroup III were little higher than treatment group II, but the difference had nostatistically significance.CONCLUSION1. Treatment group II had the best curative effect compared to control group andtreatment group I; treatment group II and III had similar curative effects buttreatment group III had worse side effect.2. Through the monitoring of vital signs and laboratory indexes (PLT, PT,APTT, FIB,BUN, CRE, ALT) there were no significant differences between groups (P>0.05),arterial catheter in treatment of acute cerebral infarction safe. Through theobservation of each group of inflammatory cytokines(IL-1β, hs-CRP, TNF-α,seventh day and fourteenth day monitoring numerical) changes in each treatmentgroup decreased significantly compared with the control group, there wasstatistically significant (P <0.05), while the treatment group III hs-CRP, IL-1β atreatment group II slightly increased, suggesting that within a reasonable period oftime (indwelling catheter3days) of the arterial catheter is safe and does notincrease the inflammatory reaction. During the processing of group therapy doesnot appear serious life-threatening complication.3. Safe and effective in the treatment of acute cerebral infarction in3indwellingcatheters, the treatment group II was the best method of treatment of clinical.