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[摘要]
目的 探讨藻酸双脂钠联合阿替普酶治疗脑梗死的临床效果。方法 选取2016年6月—2018年6月在亳州市人民医院治疗的急性脑梗死患者98例,随机分为对照组(49例)和治疗组(49例)。对照组静脉滴注注射用阿替普酶,0.9 mg/kg加入生理盐水,最大剂量90 mg,总剂量的10%静脉推注,剩余剂量在60 min内持续静脉滴注,1次/14 d。治疗组在对照组基础上加用注射用藻酸双酯钠,1~3 mg/kg加入250 mL生理盐水,滴速小于0.75 mg/(kg·h),1次/d,每天最大剂量150 mg。两组患者均治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者脑梗死体积、NIHSS评分、BI指数、血流学指标和血清炎性因子水平。结果 治疗后,对照组的总有效率为77.55%,显著低于治疗组的89.80%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组脑梗死体积和NIHSS评分显著降低(P<0.05),BI指数显著升高(P<0.05),且治疗后治疗组上述指标明显好于对照组(P<0.05)。治疗后,治疗组患者全血高切黏度、全血低切黏度和血浆黏度均显著下降(P<0.05),且治疗组这些指标明显低于对照组(P<0.05)。治疗后,两组患者血清白细胞介素-6(IL-6)、IL-8、IL-10、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平均显著降低(P<0.05),且治疗组这些血清炎性因子水平明显低于对照组(P<0.05)。结论 藻酸双脂钠联合阿替普酶可显著降低血清炎性因子,促进神经功能的恢复,提高临床治疗总有效率,具有一定的临床推广应用价值。
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[Abstract]
Objective To explore the clinical effect of polysaccharide sulphate combined alteplase in treatment of acute cerebral infarction. Methods Patients (98 cases) with acute cerebral infarction in Bozhou People's Hospital from June 2016 to June 2018 were randomly divided into control (49 cases) and treatment (49 cases) groups. Patients in the control group were iv administered with Alteplase for injection, 0.9 g/kg added into normal saline, the maximum dose was 90 mg, and intravenous injection of 10% of total dose, then the remaining dose was administered in 60 min, once every 14 d. Patients in the treatment group were iv administered with Alginic Sodium Diester for injection on the basis of the control group, 1-3 mg/kg added into 250 mL normal saline, the dripping speed was less than 0.75 mg/(kg·h), once daily, and the maximum dose was 150 mg. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the cerebral infarct volume, NIHSS scores, BI indexes, the hemodynamic indicators and the serum inflammatory factors levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 77.55%, which was significantly lower than 89.80% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the cerebral infarct volume and NIHSS scores in two groups were significantly decreased (P<0.05), but BI indexes were significantly increased (P<0.05), and these indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the whole blood high viscosity, whole blood low viscosity and plasma viscosity in two groups were significantly decreased (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the serum IL-6, IL-8, IL-10, TNF-α and CRP levels in two groups were significantly decreased (P<0.05), and the serum inflammatory factors levels in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Polysaccharide sulphate combined alteplase in treatment of acute cerebral infarction can decrease the serum inflammatory factors, promote the recovery of nerve function, improve the treatment effective rate, which has a certain clinical application value.
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