| Background:Compared with foreign countries,China has a low thrombolysis rate and a long pre-hospital delay,which is mainly due to the relatively few stroke 120 network model construction in China,uneven regional distribution,relatively weak comprehensive treatment and advanced support capacity,and the network system needs to be further improved.Previous studies have shown that intravenous thrombolysis can improve the recovery of motor function in patients with Acute Ischemic stroke?AIS?and reduce the disability rate.Cognitive impairment is one of the common symptoms of Ischemic stroke[3-4].Currently,there are few studies on the effect of thrombolysis on cognitive function in patients with mild and medium-sized Acute Ischemic stroke.Objective:A prospective study was conducted to investigate the efficacy of rt-PA intravenous thrombolysis in mild and moderate AIS patients with stroke in 120 network mode,and the changes of Cognitive function after thrombolysis were analyzed by Birmingham Cognitive Screen?BCoS?.Method:Prospective straight into between January 2019 and January 2020 the first people's hospital of guangzhou nansha neurology hospital diagnosed light medium and 44 patients with acute ischemic stroke thrombolysis treatment,according to the different ways to nansha hospital patients with can be divided into two groups,one by the 120 network sent to the hospital treated 25 cases of stroke patients in group A,go to the hospital treatment of19 patients in group B.?1?The length of hospital stay,drug compliance,recurrence rate,baseline and clinical data of the two groups were recorded to compare the differences between the two groups.Baseline data included age,sex,education,risk factors associated with cerebrovascular disease?hypertension,hyperlipidemia,history of coronary heart disease,diabetes,history of atrial fibrillation,cerebral artery stenosis,history of tobacco and alcohol,carotid plaque,homocysteine,ejection rate,and associated inflammatory factors?.Clinical data included whether the patient visited the hospital through stroke 120 network,ONT of the patient,DNT time,etc.?2?After thrombolysis for 24 hours,the patients in the two groups were reexamined by plain head CT scan to remove cerebral hemorrhage,and the Computed Tomography Perfusion?MRP?assessment of the head was respectively completed within 3-4 days after thrombolysis.During hospitalization,ECG,cardiac color ultrasound and cervical vascular color ultrasound were all performed.?3?all patients after admission into the group were made by the professional training of the neurologist clinicians use America's National Institutes of Health Stroke Scale?National Institutes of Health Stroke Scale,NIHSS?on neural function defect Scale,further telephone follow-up after discharge Modified Rankin Scale?Modified Rankin Scale,mRS?and NIHSS Scale to detect the two groups after thrombolysis in patients with the recovery of neural function defect degree,MR perfusion imaging was performed by one or two radiologists to assess the low perfusion volume and infarct site.Continue to follow-up of A,B two groups of patients with 7 days after thrombolysis,30 days,the 90th day of neuropsychological examination,including MMSE,MoCA,BCoS rating scale,and followed up for 7 days after thrombolysis,30 days,the 90th day mRS score and NIHSS score,evaluate and compare the two groups after thrombolysis in patients with different period of prognosis and the change of cognitive function and clinical observation of different brain infarction cognitive areas of damage in patients with AIS.Efficacy evaluation.methods:The NIHSS score of mild and medium-sized stroke was 1-15 points,and the recovery effect was that the NIHSS score after rt-PA intravenous thrombolysis treatment was no less than 4 points or reduced to 0 points compared with that before discharge.MRS score was used as the standard for prognosis assessment.The score of 90dmRS was 0-2,indicating good prognosis,and the score of 3-6 was defined as poor prognosis.Results:?1?A,B two groups of patients with gender,age,risk factors related to education age,cerebrovascular disease,hypertension,hyperlipidemia,diabetes,atrial fibrillation,coronary heart disease,history of alcohol,tobacco,just before bed,high blood pressure and carotid plaques and intracranial artery stenosis,homocysteine,ejection fraction),etc.There was no significant difference?p>0.05?.?2?Patients in group A and group B were compared at ONT and DNT time,and DNT and ONT time in group A was significantly shorter than that in group B,and the difference was statistically significant?p=0.026,p=0.000?.?3?Chi-square test was significant in the prognosis evaluation of mRS in group A and group B?p=0.013?.In group A,the number of cases with good clinical prognosis was 19,accounting for 79.2%;in group B,the number of cases with good clinical prognosis was 8,the proportion of good prognosis was 42.1%,and the chi-square test value of the rate between the two groups was 6.234.By comparing the proportion of the number of cases of patients with mRS of 0-2 at 90 days,it can be seen that the proportion of patients in group A who achieved good clinical transition was higher than that in group B.DNT OR=1.14,p<0.05,ONT OR=1.13,p<0.05,as indicated by binary Logistic regression,DNT OR=1.14,p<0.05,ONT OR=1.13,p<0.05,indicating that DNT and ONT had a significant impact on MRS prognosis evaluation.ROC curve was used to analyze DNT and ONT to test the area under the curve of 90dmRS score of patients with light and medium AIS intravenous thrombolysis.The area under DNT curve was 0.964,p=0.000<0.05,and the area under ONT curve was 0.930,p=0.000<0.05,all of which were statistically significant,indicating that DNT and ONT were statistically significant in the diagnosis of MRS prognosis evaluation.?4?NIHSS score on the 30th day after thrombolysis in group A was lower than that before discharge,and the difference was statistically significant?p=0.000?.NIHSS score on the 90th day after thrombolysis in group A was lower than that before discharge?p=0.000?.NIHSS score on the 30th day after thrombolysis in group B was not significantly different from that before discharge?p=0.0096?.NIHSS score on the 90th day after thrombolysis in group B was lower than that before discharge?p=0.000?.The NIHSS scores of group A on day 30 and day 90 after thrombolysis were significantly shorter than those of group B?p=0.001,p=0.001?.?5?In group A?doctor?by the network to 120 yuan of the 30th day after thrombolysis treatment MMSE score after treatment compared with 7 days there was no statistically significant difference?p>0.05?,group B?on their own to school clinic group?30 days after thrombolysis treatment,the 90th day of MMSE score after treatment compared with 7days there was no statistically significant difference?p>0.05?.The total score of MMSE,MoCA on day 30 and MoCA on day 90 after thrombolysis in group A was higher than that before discharge,and the differences were all significant?p=0.005,p=0.000,p=0.000?.The total score of MoCA on day 30 and MoCA on day 90 after thrombolysis in group B was higher than that before discharge?p=0.000?.There was no statistically significant difference between the two groups?p>0.05?.The MMSE total score,MoCA total score on day 30 and day 90 after thrombolysis in patients in group A were all higher than those in group B?p=0.047,p=0.000,p=0.000?.?6?There was no significant difference in the total score of the BCoS scale and the evaluation scores in each region between group A?patients who visited the hospital via120 Internet?and group B?patients who visited the hospital by themselves?on the 7th day of thrombolysis?p>0.05?.The total score of auditory attention on the 30th day after thrombolysis was significantly improved in both groups?p<0.05?.The deletion accuracy of apple was significantly improved?all p<0.05?.The image naming scores were significantly improved?all p<0.05?.BCoS scale results show two groups of patients after thrombolysis treatment in Birmingham,auditory attention to score,day 90 rules fractional conversion,identification number,apple removed the accuracy,false words,picture naming,the sentence read time reading time,delayed recall and delayed recognition is improved than 7 days after treatment,the differences were statistically significant?p<0.05?.The comparison between groups A and B showed that the total score of auditory attention,apple deletion accuracy and image naming scores of patients in group A were significantly better than those in group B on the 30th day after treatment?p=0.034,p=0.001,p=0.000?.On the 90th day after treatment,the total score of auditory attention,Birmingham rule conversion score,rule recognition number,apple deletion accuracy,picture naming,sentence reading time,false word reading time,delayed recall and delayed recognition in group A were better than those in group B?p=0.034,p=0.041,p=0.004,p=0.001,p=0.002,p=0.000,p=0.001,p=0.004,p=0.004,p=0.004?.?7?A,B two groups appear in the left hemisphere low perfusion in patients with A total of 26 cases,appear on the right side of the brain hemisphere low perfusion of A total of 18cases,this study AIS patients with auditory attention scores decline of cerebral hypoperfusion area are mainly distributed in bilateral frontal temporal lobe,occipital lobe,apple delete test scores decline of cerebral hypoperfusion area are mainly distributed on the left side of the frontal temporal lobe,left thalamus and occipital lobe;The cerebral hypoperfusion region with prolonged delayed recall time was mainly distributed in bilateral frontotemporal lobes,dominated by dominant hemisphere.The hypoperfusion regions with prolonged delay recognition time were mainly distributed in the left parietal lobe,right thalamus,left occipital lobe and bilateral frontotemporal lobe.The brain hypoperfusion areas with prolonged sentence reading time were mainly distributed in frontal and temporal lobes.Bilateral parietal lobe was the main distribution of the cerebral hypoperfusion region with decreased Birmingham conversion rule score.90dmRS?0 to 2?points,the left hemisphere low perfusion in patients is significantly higher than the proportion of the right hemisphere low perfusion?p=0.037?,the left hemisphere low perfusion in patients with apple delete accuracy scores decline rate is significantly higher than the right hemisphere low perfusion?p=0.031?,the left hemisphere low perfusion in patients with a sentence read extension ratio is significantly higher than the right hemisphere low perfusion?p=0.005?,There was no significant difference in the proportion of total decreased auditory attention,delayed recall time,delayed recognition time and Birmingham transition rule score in patients with left cerebral hemisphere hypoperfusion?p>0.05?.Conclusion:?1?The activation of 120 network stroke early warning in pre-hospital emergency treatment is conducive to shortening the treatment time window.Timely and correct intravenous thrombolysis in the 120 network mode of stroke can promote the recovery of motor function in mild and medium-sized AIS patients and improve the therapeutic effect of thrombolysis.?2?The construction of the 120 network model for regional medical association stroke can reduce the degree of cognitive impairment in patients with mild and medium-sized AIS thrombolysis;The Birmingham Cognitive Assessment Scale?BCoS?is a neuro-psychological assessment tool involving a wide range of cognitive domains,which can assess the impact of intravenous thrombolysis on the cognitive function changes of patients with mild and medium-sized AIS,especially in the aspects of memory,language ability and attention.?3?The hypoperfusion brain region shown by magnetic resonance perfusion imaging in acute ischemic stroke has important clinical significance in guiding the evaluation of cognitive impairment in AIS patients after stroke. |
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