| OBJECTIVEWith acute infarction gradually increased diabetes risk factors, hypertension, high cholesterol incidence, ACI incidence increases. ACI is due to atherosclerosis or other causes brain artery stenosis, occlusion, and cerebral arterial supply area is not timely formation of collateral circulation, resulting in insufficient blood supply to the local brain tissue, nerve cells in the brain tissue of oxygen due to no adequate supply, causing cellular energy metabolism, the last part of ischemic neuronal or glial cell damage occurs, apoptosis or necrosis, clinical manifestations performance is central nervous system damage, such as central nervous system systemic paralysis. The study found the ACI ultra-early thrombolytic restore blood supply to the ischemic area may reduce ischemic penumbra ischemic neuronal damage, restore the function of nerve cells. But for clinical usage for the UK there is no obvious requirement, and some researchers believe that large doses can lead to increased bleeding complications UK, it advocates the use of small doses of UK, some researchers believe that small doses of UK and not timely thrombolysis, then through blood vessels, delays in rescue nerve cells, brain hemorrhage and thrombolysis with UK usage without direct contact, so the UK advocate the use of high-dose therapy. In this study, ACI patients for the study, to explore the efficacy of different doses of UK and complications, and to study the factors UK thrombolytic efficacy and complications of therapy for clinical use UK ACI, ACI improve prognosis theoretical reference.METHODChoose from December2012to December2013in our hospital109cases of patients diagnosed with acute cerebral infarction,68cases were male, aged42-73years, mean age (59.39±14.82) years, female41cases, aged42-71years, mean age (58.42±14.09) years of age. The patients were divided according to therapeutic doses UK25×104U group, UK45x104U group, UK75x104U group, UK150x104U group and the control group, which is the basis for the control group of patients treated,20cases, UK25x104U group,22cases, UK45x104U group,22cases,22cases of UK75×104U group, UK150x104U group,23cases Observed before and after treatment of the following indicators after thrombolytic recanalization cases, motor function, neurological levels and activities of daily living, clinical assessment of the efficacy, safety assessment, the factors affecting the efficacy of the situation.RESULTS1movement of patients at each time point before and after treatment and the treatment of functional conditionsComparison of the group, the control group,25×104U group,45x104U group,75x104U group,150x104U group of motor function after prolonged treatment score was significantly improved over time, and the difference was statistically significant (p<0.05). Between the two groups, each group before treatment motor function score difference was not statistically significant (p≥0.05), after treatment,24h25X104U group,45X104U group,75X104U group score was significantly higher in patients with motor function in the control group,150x104U group score significantly higher in patients with movement25x104U group,45×104U group,75×104U group of patients, and the difference was statistically significant (p<0.05). After treatment7d25×104U group,45×104U group was significantly higher in patients with75×104U sports group function score was significantly higher than25×104U group,45×104U group,150×104U group motor score significantly higher in patients with75×104U group of patients, and the difference was statistically significant (p<0.05). After treatment,14 d25×104U group,45×104U group was significantly higher,75×104U group score significantly higher in patients with motor function25x104U group,45x104U group,150x104U group motor score significantly higher in patients with75x104U group of patients, and the difference was statistically significant (p<0.05). After treatment,28d25x104U group,45x104U group was significantly higher,75x104U group score significantly higher in patients with motor function25x104U group,45x104U group,150x104U group motor score significantly higher in patients with75x104U group of patients, and the difference was statistically significant (p<0.05).2. Nerve function in patients with the situation at all time points before treatment and afterComparison of the group, the control group,25x104U group,45x104U group,75x104U group,150x104U group after treatment prolonged neurological deficit scores were significantly decreased with time, and the difference was statistically significant (p<0.05). Between the two groups before treatment neurological deficit scores in each group showed no significant difference (p≥0.05), after treatment,24h25X104U group, neurological patients45X104U group function defect score was significantly lower than the control group, neurological patients75x104U group function defect score was significantly lower than25x104U group,45x104U group of patients,150x104U group of patients with neurological impairment was significantly lower than the75×104U group of patients, and the difference was statistically significance (p<0.05). After treatment7d25x104U group, neurological patients45x104U group function defect score was significantly lower than the control group, patients with75×104U neurological deficit scores were significantly lower than group25×104U group,45×104U group patients, patients with150×104U nerve function defect group was significantly lower than the75x104U group of patients, and the difference was statistically significant (p0.05). After treatment,14d25x104U group, neurological patients45x104U group function defect score was significantly lower than the control group, patients with75x104U neurological deficit scores were significantly lower than group25x104U group,45x104U group patients,150x104U group scores were significantly lower in patients with movement75×104U group of patients, and the difference was statistically significant (p0.05). After treatment,28d25x104U group,45x104U neurological function in patients was significantly lower than the control group, patients with75x104U neurological deficit scores were significantly lower than group25x104U group,45x104U group patients, patients with150x104U nerve function defect group was significantly lower than the75x104U group of patients, and the difference was statistically significant (p<0.05).3-point daily living conditions of patients at each time after treatmentComparison of the group, the control group,25x104U group,45x104U group,75x104U group,150x104U group increased significantly from7d after treatment began with time BI, and the difference was statistically significant (p<0.05). Between the two groups, BI difference between groups was not statistically significant before treatment (p≥0.05),24h BI difference between the groups of patients after treatment was not statistically significant (p≥0.05). After treatment7d25X104U group, BI patients45x104U group was significantly higher, BI patient75x104U group was significantly higher than the25×104U group,45x104U group of patients,150x104U BI patients was significantly higher than75x104U group of patients, and the difference was statistically significant (p<0.05). After treatment,14d25x104U group, BI patients45x104U group was significantly higher, BI patient75x104U group was significantly higher than the25 x104U group,45x104U group of patients,150x104U BI patients was significantly higher than75x104U group of patients, and the difference was statistically significant (p<0.05). After treatment,28d25x104U group, BI patients45x104U group was significantly higher, BI patient75x104U group was significantly higher than the25x104U group,45x104U group of patients,150x104U BI patients was significantly higher than75x104U group of patients, and the difference was statistically significant (p<0.05).4patients with vascular recanalization25x104U group, recanalization rate45x104U group was significantly higher,75x104U group,150x104U group recanalization rate was significantly higher than the25x104U group,45x104U group, and the difference was statistically significant (p<0.05). Where25x104U group,45x104U group complete recanalization rate was significantly higher,75x104U group complete recanalization rate was significantly higher than the25x104U group,45x104U group,150x104U group complete recanalization rate was significantly higher than the75X104U group, part of the recanalization rate of the control group,25X104U group,45X104U group,75X104U group difference was not statistically significant (p≥0.05), partial recanalization rate of150x104U group was significantly lower than the previous four groups, and the difference was statistically significant (p<0.05).5cases of clinical efficacy in patients with25x104U group, there are always45x104U group was significantly higher, and the total75x104U group was significantly higher than25x104U group,45×104U group,150×104U group the total effective rate was significantly higher than75×104U group, and the difference was statistically significant (p<0.05). Where25×104U group, the proportion of patients cured of45×104U group was significantly higher than the proportion of patients cured of75x104U group was significantly higher than25x104U group,45x104U group,150x the proportion of patients cured of104U group was significantly higher than75x104U group, and the difference was statistically significant (p<0.05). The proportion of patients the efficacy of75x104U group was significantly higher than the25x104U group,45x104U group, efficacy was significantly U proportion of patients was significantly higher than the150x10475x104U group, and the difference there was statistically significant (p<0.05).75x104U ratio of effective patient treatment group was significantly higher than150x104U group and the control group,25x104U group, the proportion of45x104U group treatment is effective in patients was significantly higher than75x104U group, and the difference statistical significance (p<0.05).6Treatment security situationPatients in each group the number of cases of intracranial hemorrhage, the difference was not statistically significant (p≥0.05) between the number of cases of other systems bleeding and bleeding complication rate group.7Univariate analysis of factors affecting the clinical efficacy and complications.Effective treatment of patients with BG, invalid thrombolysis time window, UK dose, LDL, HDL, TC, TG and treatment compared with patients or worsening significantly (p<0.05), single factor influencing factors of bleeding complications the results of the presence of bleeding complications in patients with BG, the incidence of thrombolysis time window, UK dose, LDL, HDL, TC, TG, hypertension, diabetes compared with patients without bleeding complications, the difference was statistically significant (p<0.05).8Multi-factors of the clinical efficacy and complications Logistic regression analysis BG, thrombolysis time window, MCA occlusion as risk factors for clinical efficacy, UK dose of protective factors influencing factors of bleeding complications multivariate Logistic regression analysis showed that BG, thrombolytic time window, MCA occlusion, LDL, high blood pressure diabetes bleeding complications after thrombolytic influence of risk factors.CONCLUSIONAn ultra early use of large doses of UK significant effect.2UK super-early use of high-dose and low-dose bleeding complications UK same.3. BG, thrombolytic time window, MCA occlusion as risk factors for clinical efficacy, UK dose of protective factors, BG thrombolysis time window, MCA occlusion, LDL, high blood pressure, diabetes, bleeding complications after thrombolysis impact of risk factors. |
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