Clinical Study Of TCD Combined With Coagulation Parameters In Intravenous Thrombolysis Of Acute Ischemic Stroke

BackgroundAcute ischemic stroke(AIS)causes vascular occlusion from various causes and leads to ischemic and hypoxia of the surrounding brain tissue and brain cell death from ischemic stroke,presenting neurological defects clinically.AIS is one of the main causes of death and disability in Chinese patients,with high morbidity,disability,recurrence and fatality rates.At present,the most critical method for the treatment of AIS patients is early intravenous thrombolysis.In clinical practice,even if alteplase(rt-PA)is actively given to AIS patients within the time window of onset,some patients will still show other neurological defects such as hemiplegia and disability.Among them,rt-PA is the most widely used in clinical practice.Therefore,early active evaluation of hemodynamic changes after intravenous thrombolysis is of great significance for predicting clinical prognosis.At present,the commonly used vascular examination methods in clinical practice all have certain deficiencies.Transcranial Doppler color ultrasound(TCD)is a non-invasive,common examination technique that can monitor changes in cerebral hemodynamics,and is safe,portable and can be operated in real-time at the bedside.Currently,it has been widely used in clinical practice,and can effectively predict the development and prognosis of patients.TCD plays a good role in determining the main collateral circulation and intracranial arterial stump blood flow.At present,it has been proved that coagulation parameters play a certain early warning role in the prognosis of rt-PA intravenous thrombolysis and coagulation parameters are now generally recognized as laboratory indicators of bleeding and thrombotic related diseases.Therefore,by observing and analyzing the symptoms of short-term neurological impairment in patients with rt-PA intravenous thrombolytic therapy in acute ischemic stroke and comparing the clinical data of patients with different clinical symptoms,this study aims to analyze the correlation between TCD and coagulation parameters and the symptoms of short-term neurological impairment in patients with intravenous thrombolytic therapy,so as to provide basis for clinical individualized treatment.ObjectiveTo investigate the application value of TCD combined with coagulation parameters in intravenous thrombolysis in acute ischemic stroke,and to analyze the related factors affecting the symptoms of neurological impairment in intravenous thrombolysis.Methods104 patients with acute anterior circulation cerebral infarction who received intravenous thrombolysis with rt-PA in X Hospital Affiliated to Anhui Medical University from August 2021 to May 2022 were selected as subjects.According to the decrease of NIHSS score 7 days after thrombolysis,patients were divided into two groups: NIHSS score decreased by 46%～100%(57 cases),namely group A,and NIHSS score decreased by less than 46%(47 cases),namely group B.The whole set of liver function,renal function,electrolyte and coagulation,as well as general clinical data(gender,age,past history,systolic blood pressure and diastolic blood pressure at admission)of all the enrolled patients were collected and given transcranial Doppler(transcranial Doppler)24 h after thrombolysis.The change of NIHSS score 7 days after thrombolysis was recorded.By comparing the decline of TCD parameters and NIHSS score 24 hours after thrombolysis,the prediction value of the above indexes for short-term neurological impairment in patients with cerebral infarction was analyzed.Results:(1)General clinical data: there were no statistically significant differences between group A and group B in age,history of hypertension,history of atrial fibrillation,history of smoking,history of drinking,and diastolic blood pressure at admission,while there were statistically significant differences in history of diabetes and systolic blood pressure at admission between the two groups(P < 0.05).(2)Serological indexes: there were no statistical differences between group A and group B in platelet count,triglyceride,cholesterol,APTT,PT,INR and TT,while there were statistical differences between the two groups in glycosylated hemoglobin,FIB and D-D(PI value: there were statistical differences in PI values of the basically cured,significantly effective,progressive and ineffective groups(p < 0.05).Dunn’s test was used to compare groups,and there were statistical differences in PI values between the basically cured group and the progressive group(p < 0.05),and between the basically cured group and the ineffective group(p < 0.01).(4)Correlation analysis of NIHSS score showed that the NIHSS score 24 hours after thrombolysis was significantly correlated with the effective and ineffective groups(Pand the NIHSS score 7 days after thrombolysis was correlated with the effective,progressive and ineffective groups(p < 0.05).(5)Independent risk factors for early neurological impairment after thrombolysis:binary Logostic regression analysis showed that HBA1 c was an independent risk factor for poor outcome(P<0.05).Conclusion:The combination of TCD and coagulation parameters can effectively evaluate and predict the improvement of nerve function after thrombolysis with rt-PA,which has certain clinical application value.