The Effect Of Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator On Cerebrovascular Reserve Capacity In Patients With Acute Cerebral Infarction

BackgroundAcute cerebral infarction is clinically common diseases,because of its high incidence,high mortality,high disability rate,high recurrence rate,the cure rate is low,the human health and life of the great harm,but also work and life brought great inconvenience to the normal families of patients and patients.Therefore,the effective treatment of acute cerebral infarction is very urgent.The treatment of acute cerebral infarction is the most important early recanalization.Thrombolytic therapy has become the preferred solution for hyperacute ischemic stroke,and recombinant tissue plasminogen activator is currently the only official drug for ultra early thrombolytic therapy.Cerebrovascular reserve capacity is very important to the stability of brain function.Abnormal cerebrovascular reserve capacity is also closely related to stroke.Cerebrovascular reserve capacity,if not treated in time,the risk of stroke will also be significantly increased.Transcranial Doppler can be convenient,quick,and noninvasive monitoring of the flow velocity of the large intracranial artery,thus indirectly reflecting the cerebral blood flow.It is a better way to evaluate cerebral vasomotor response by quantitative measurement of cerebrovascular reserve capacity by measuring blood flow velocity by TCD combined with breath-holding test.ObjectiveThe clinical curative effect of the patients with acute cerebral infarction before and after thrombolytic therapy with intravenous rt-PA observation,comparative analysis and the influence on cerebrovascular reserve capacity,based on the change of cerebrovascular reserve,to evaluate the efficacy of thrombolytic therapy,prognosis and risk of stroke,and provide experimental basis for clinical efficacy of thrombolytic therapy and long-term prognosis.MethodsA total of 30 cases of patients with acute cerebral infarction from January 2016 to December 2016 treatment in the neurology department in our hospital as the research object.All patients were the first occurrence of cerebral infarction in the middle cerebral artery area,and within 4.5 hours of the onset of hospitalized.All patients were in line with Chinese medicine intravenous thrombolysis in acute cerebral infarction indications.All patients have good conditions for TCD check.All patients were given rt-PA intravenous thrombolytic therapy in 4.5 hours,24 hours after the exclusion of bleeding and other adverse reactions after treated with anti platelet aggregation,protecting vascular endothelium,scavenging oxygen free radicals and nerve nutrition therapy,and appropriate antihypertensive drugs,hypoglycemic,hypolipidemic drugs.The systolic blood flow velocity(Vs)and diastolic blood flow velocity(Vd)of bilateral MCA were measured by TCD before and 7 days and 90 days after thrombolysis,and the mean flow velocity(Vm)and pulsatility index(PI)were calculated.The breath holding time(BHI)and CVR(%)were calculated and recorded by the breath holding test,and the changes of Vm were recorded and calculated.The results of CVR were standardized.At the same time compared with patients in thrombolytic therapy before and after thrombolytic therapy for 7 days and 90 days of NHISS score,BI score,curative effect and prognosis of thrombolytic therapy were analyzed;and analyze the changes of CVR before and after thrombolytic therapy,the correlation analysis of clinical efficacy of the combination of.ResultsParticipants in the study received rt-PA intravenous thrombolytic therapy before the NIHSS score was 13.57±3.09,8.69±2.74 to 7 days after treatment,90 days after treatment further decreased to 6.37±3.56,27.00±9.06BI score before treatment,7 days after treatment increased to 50.17±14.11,90 days after treatment further increased to 65.83±16.81,indicates that the patient’s neurological function and activities of daily living were improved,and with the extension of time is more significant(P<0.05);thrombolytic therapy in patients with CVR was(20.41±2.07)%,up to 7 days after treatment(22.47±3.14)%,90 days of treatment further increased to(28.58±7.98)%,showed that patients with CVR have also been improved,and with the increase of time effect is more significant(P<0.05).After treatment,the number of basic rehabilitation was 2,the number of effective treatment was 7,the effective number was 15,the total effective rate was 80%(24/30).ConclusionThis study shows that:rt-PA intravenous thrombolytic therapy can significantly improve patients with acute cerebral infarction and cerebrovascular reserve function;changes in blood flow velocity measurement of TCD combined with breath holding test to the quantitative detection of CVR provides effective experimental basis for clinical thrombolytic therapy efficacy and long-term prognosis.