Mild hypothermia combined with intravenous thrombolytic therapy can improve cognitive functioning and stress response after cerebral infarction / 中华物理医学与康复杂志

ABSTRACT

Objective To explore the effect of combining mild hypothermia with intravenous thrombolytic therapy on the cognitive functioning and stress response of persons with acute cerebral infarction.Methods A total of 126 patients with acute cerebral infarction were randomly divided into a control group,a study group 1 and a study group 2,each of 42.All three groups were given intravenous thrombolytic therapy,while study group 1 also received 12 hours of mild hypothermia,and study group 2 received 24 hours.Before the treatment and 1,7,14,30 and 90 days later the National Institutes of Health stroke scale (NIHSS) was used to evaluate the subjects' nerve functions.Intracranial pressure,oxidative stress,and inflammatory cytokine levels were also measured before the treatment and 2,3 and 7 days afterward.Results The average NIHSS scores of both study groups were significantly lower than that of the control group at each time point after the treatment.Study group 2 showed significantly greater improvement than study group 1.The total effectiveness rate was 76.2％ in study group 1 and 85.7％ in study group 2,both significantly better than in the control group but without significant difference between the study groups.Both study groups' average intracranial pressures were significantly lower than the control group's average after the treatment.Moreover,3 and 7 days after the treatment,the average intracranial pressure of study group 2 was significantly lower than study group 1's average.After 1,3 and 7 days,significant differences in superoxide dismutase and malondialdehyde levels were observed between the study groups and the control group.Three days after the treatment,the average TNF-α,IL-1β and IL-6 levels of the study groups were significantly lower than the control group's average,and those of study group 2 were significantly lower than those of study group 1.The total incidence of adverse reactions was not significantly different among the 3 groups.Conclusion For patients with acute cerebral infarction,thrombolytic therapy combined with mild hypothermia for 24 hours has a definite curative effect.It can improve intracranial pressure,reduce oxidation and inflammation and improve neurological function.The patients recover well.The combined therapy is safe and worthy of clinical application.