目的 探討依達(dá)拉奉聯(lián)合阿替普酶靜脈溶栓治療老年缺血性腦血管病的臨床療效。方法 選取2019年1月—2021年1月朝陽(yáng)市第二醫(yī)院就診并治療的老年缺血性腦血管病患者90例為研究對(duì)象，按照治療方法的不同將其分為對(duì)照組和觀察組，每組均45例。對(duì)照組采用阿替普酶0.9 mg/kg靜脈溶栓治療，其中10%于1 min內(nèi)進(jìn)行靜脈推注，剩余90%＋250 mL0.9%氯化鈉注射液行靜脈滴注，注意最大用藥劑量不超過(guò)80 mg。觀察組患者在對(duì)照組基礎(chǔ)上靜脈滴注依達(dá)拉奉注射液，30 mg＋100 mL 0.9%氯化鈉注射液，2次/d。兩組患者均治療2周。觀察兩組患者的臨床療效，對(duì)比兩組治療前后的NIHSS評(píng)分、血清氧化應(yīng)激指標(biāo)、炎癥因子指標(biāo)及腦血流速度等。結(jié)果 治療后，觀察組的總有效率為95.56%，明顯高于對(duì)照組的80.00%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組經(jīng)過(guò)治療后NIHSS評(píng)分均較治療前明顯降低（P<0.05），且觀察組NIHSS評(píng)分明顯低于對(duì)照組（P<0.05）。兩組經(jīng)過(guò)治療后的超氧化物歧化酶（SOD）、谷胱甘肽過(guò)氧化物酶（GSH-Px）均較治療前明顯升高（P<0.05），且觀察組SOD、GSH-Px均明顯高于對(duì)照組，有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組經(jīng)過(guò)治療后的丙二醛（MDA）較治療前明顯降低（P<0.05），且觀察組MDA明顯低于對(duì)照組，有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組經(jīng)過(guò)治療后C反應(yīng)蛋白（CRP）、白細(xì)胞介素-6（IL-6）、_γ-干擾素（IFN_-γ）水平均較治療前明顯降低（P<0.05），且觀察組CRP、IL-6、IFN_-γ水平均明顯低于對(duì)照組（P<0.05）。兩組經(jīng)過(guò)治療后腦血流速度均較治療前明顯升高（P<0.05），且觀察組腦血流速度均明顯高于對(duì)照組（P<0.05）。結(jié)論 依達(dá)拉奉聯(lián)合阿替普酶靜脈溶栓治療缺血性腦血管病的效果較好，可有效改善患者的NIHSS評(píng)分，抑制炎癥因子水平，調(diào)節(jié)血清氧化應(yīng)激指標(biāo)與腦血流速度，值得臨床應(yīng)用。

Objective To investigate the clinical effect of edaravone combined with alteplase in treatment of senile ischemic cerebrovascular disease. Methods A total of 90 elderly patients with ischemic cerebrovascular disease treated in the Chaoyang Second Hospital from January 2019 to January 2021 were selected as the research subjects. According to the different treatment methods, they were divided into control group and observation group, with 45 cases in each group. Patients in the control group were intravenous thrombolytic therapy with alteplase at 0.9 mg/kg, in which 10% was injected intravenously within 1 min, and the remaining 90% + 250 mL 0.9% sodium chloride injection was injected intravenously, noting that the maximum dose was not more than 80 mg. Patients in the observation group were iv administered with Edaravone Injection on the basis of control group, 30 mg + 100 mL 0.9% sodium chloride injection, twice daily. Patients in both groups were treated for 2 weeks. Clinical efficacy of two groups was observed, and NIHSS score, serum oxidative stress index, inflammatory factors index, and cerebral blood flow velocity before and after treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 95.56%, significantly higher than 80.00% of the control group, and the difference between the two groups was statistically significant (P < 0.05). After treatment, NIHSS scores in two groups were significantly lower than those before treatment (P < 0.05), and the NIHSS scores in observation group were significantly lower than those in control group (P < 0.05). After treatment, the levels of SOD and GSH-Px in two groups were significantly higher than before treatment (P < 0.05), and SOD and GSH-Px in the observation group were significantly higher than those in the control group, with statistical significance (P < 0.05). The MDA of two groups was significantly lower than that before treatment (P < 0.05), and the MDA of the observation group was significantly lower than that of the control group, with statistical significance (P < 0.05). After treatment, the levels of CRP, IL-6, and IFN_-γ in two groups were significantly decreased compared with before treatment (P < 0.05), and the levels of CRP, IL-6 and IFN_-γ in observation group were significantly lower than those in control group (P < 0.05). After treatment, the cerebral blood flow velocity of both groups was significantly higher than that before treatment (P < 0.05), and the cerebral blood flow velocity of observation group was significantly higher than that of control group (P < 0.05). Conclusion Edaravone combined with alteplase has a good effect on intravenous thrombolysis of ischemic cerebrovascular disease, which can effectively improve patients' NIHSS score, inhibit the level of inflammatory factors, regulate serum oxidative stress indexes and cerebral blood flow velocity, and is worthy of clinical application.

R971

遼寧省自然科學(xué)基金資助項(xiàng)目（20180550283）