Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации6711UnclassifiedHOW TO PUT INTO PRACTICE MODERN APPROACHES TO THROMBOLYSIS AGAINST THE BACKGROUND OF A SEVERE COURSE OF ARTERIAL HYPERTENSIONElizarovaTatyana Smitsu099@mail.ruhttps://orcid.org/0000-0002-4695-3697DmitriiKutachov Vdimakutash2002@mail.ruhttps://orcid.org/0000-0001-7396-4431Voronezh State Medical University named after N.N. Burdenko1405202110S12632642603202112042021Copyright © 2021, Молодежный инновационный вестник2021<p>Relevance. Ischemic stroke accounts for 85% of all. Currently, there are theories of the "therapeutic window" and the theory of the "ischemic cascade" [1,5]. In most cases, a stroke is disabling; only 10-13% of patients return to their previous life.<br />Purpose of the study. To evaluate the ways of implementing modern approaches to thrombolysis against the background of severe course of arterial hypertension (AH).<br />Materials and methods. We examined a 58-year-old woman with a diagnosis of lacunar ischemic stroke in the basin of the right middle cerebral artery, syndrome of left-sided hemiparesis, dysarthria. Were identified (CT) small cysts in both hemispheres of the brain (GM), mainly in the parietal lobes, and the absence of clear boundaries between the gray and white matter of the GM without clear focal signs of hypodensity. Testing was performed according to standard methods - NIHSS 17 points, Glasgow Coma Scale (GCS) 15 points, Rehabilitation Routing Scale (SRM) 5 points, Rivermead Index (IR) 0 points. The treatment was carried out in accordance with the Russian clinical guidelines for the management of patients with IS. Duplex ultrasound scanning of the brachiocephalic arteries revealed signs of atherosclerotic lesions of the great vessels at the extracranial level and stenosis of the left common carotid artery in the area of the bulb (50%). ECHO-KG reveals intact left ventricular function without signs of myocardial hypertrophy. After the transfer of the patient to the department, drug therapy and a rehabilitation plan were developed.<br />Results. Standard techniques were repeated - NIHSS 9 points GCS -15 points, SRM-3 points, IR 10 points. The results of the second stage were regression of hemiparesis and left hemiparesis, mild dysarthria, independent movement; NIHSS 5 points, GCS 15 points, SRM 1 point IR - 13 points. The patient continued to have minor limitations in self-care.<br />Output. With a timely visit to a doctor, the use of the drug alteplase, control of blood pressure, with the observance of the thrombolytic therapy protocol, one can observe good and stable results of the treatment of IS, which shows the effectiveness and appropriateness of the systemic thrombolysis technique.</p>Ischemic stroke, arterial hypertension, thrombolysis, thrombolytic therapyИшемический инсульт, артериальная гипертензия, тромболизис, тромболитическая терапия<p><strong>RELEVANCE</strong><br />In recent years, the incidence of ischemic stroke has been 85% of all. Currently, the theory of the "therapeutic window" and the theory of the "ischemic cascade" have been formed. This topic is relevant to this day, since according to the ORBI Stroke Foundation, in most cases stroke leads to disability and only 10-13% patients return to their previous life, and the consequences of a stroke and a person's life depend on how quickly medical care was provided, on the quality of treatment and subsequent rehabilitation.<br /><strong>TARGET</strong><br />To assess the ways of implementing modern approaches to thrombolysis against the background of severe hypertension.<br /><strong>MATERIALS AND METHODS</strong><br />We examined a 58-year-old woman with a preliminary diagnosis of "lacunar ischemic stroke in the basin of the right middle cerebral artery, syndrome of left-sided hemiparesis, dysarthria." On admission, CT of the brain revealed small cysts in both hemispheres of the brain, mainly in the parietal lobes, and the absence of clear boundaries between the gray and white matter of the brain without clear focal signs of hypodensity. Testing was also performed according to standard methods - NIHSS 17 points, Glasgow coma scale 15 points, 5 points according to the rehabilitation routing scale, Rivermead index 0 points. The treatment was carried out in accordance with the Russian clinical guidelines for the management of patients with ischemic stroke. In addition, additional examinations were carried out - ultrasound duplex scanning of the brachiocephalic arteries with signs of atherosclerotic lesions of the main arteries at the extracranial level and the detection of stenosis of the left common carotid artery in the area of the bulb (50%) with local hemodynamic disturbance, ECHO-KG with preserved function of the left ventricle and without signs of myocardial hypertrophy. After the transfer to the department, drug therapy was selected, and subsequently a rehabilitation technique, then it was transferred to the second stage of treatment.</p>
<p><strong>RESULTS.</strong><br />Based on the results of the examination and subsequent treatment, the standard methods were repeated - NIHSS 9 points, Glasgow coma scale 15 points, 3 points according to the rehabilitation routing scale, Rivermead index 10 points. After the first stage of treatment, the patient was transferred to the second, the results of which were as follows - regression of left-sided hemiparesis to a degree of mild, left-sided mild hemiataxia, mild dysarthria, independent movement; NIHSS 5 points, Glasgow Coma Scale 15 points, Rehabilitation Routing Scale 1 point, Rivermead Index 13 points. The patient is independent in everyday life with minor limitations in self-care. Later she was observed by a neurologist, cardiologist and therapist of the polyclinic.</p>
<p><strong>DISCUSSION</strong><br />In developed countries, thrombolysis has been used for about 10 years and is currently the most effective treatment for acute stroke [2,3,4]. However, there is an important condition for the use of thrombolytic therapy - no more than 3 hours should pass from the moment of attack to the moment of drug administration. Also, the rehabilitation process after the thrombolysis procedure takes each patient an individual period of time, and no specific figures can be given here. In our case, thrombolytic therapy showed a good and lasting result.<br /><strong>CONCLUSION</strong><br />The effectiveness and feasibility of the systemic thrombolysis technique was evaluated, which showed a good result in the treatment of ischemic stroke. We consider it expedient to use this technique.</p>[1. Джеймс Ф. Тул. Сосудистые заболевания головного мозга /перевод с анг. / Под ред. Акад. РАМН Е.И. Г усева, проф. А.Б. Гехт /Руководство для врачей : 6 изд. – М. : ГЭОТАР-Медиа, 2007. – 608 с. : ил.][2. Дутова Т.И. Генетически детерминированные факторы предрасположенности к развитию ишемического инсульта в молодом возрасте / Т.И. Дутова, В.В. Белинская, И.Э. Сазонов // Вселенная мозга. – 2019. – Т. 1. № 1 (1). – С. 8–13.][3. Куташов В.А. Влияние нейрометаболической терапии на кровоток в сосудах головного мозга / В.А. Куташов, А.А. Дудина, О.В. Ульянова, А.П. Скороходов // Вестник неврологии, психиатрии и нейрохирургии. – 2018. – № 4. – С. 3–10.][4. Неврологические и психические проявления у пациентов с ишемическим инсультом мозжечка в раннем и позднем восстановительном периодах / Ульянова О.В., Куташов В.А., Вербенко В.А. и др. // Вестник неврологии, психиатрии и нейрохирургии. – 2018. – № 6. – С. 40–44.][5. Тромболитическая терапия ишемического инсульта. Рекомендации для врачей /Н.А. Шамалов, Л.В. Стаховская. –М. МЕДпресс-информ, 2017.-80 с.: ил.]