目的 探讨蛭蛇通络联合阿替普酶治疗急性脑梗死的临床疗效。方法 选取2019年11月—2022年6月在定州市人民医院住院的120例急性脑梗死患者,随机分为对照组(60例)和治疗组(60例)。对照组患者静脉滴注注射用阿替普酶,0.9 mg/kg,最大剂量不超过90 mg,其中10%于1 min内静脉推注完毕,余药在1 h内静脉泵注。在对照组的基础上,治疗组口服蛭蛇通络胶囊,4粒/次,3次/d。两组用药14 d。观察两组患者临床疗效,比较治疗前后两组患者症状缓解时间,日常自理能力评估量表(Barthel)指数和卒中量表(NIHSS)评分,血清炎性因子肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)、白细胞介素-6(IL-6)和同型半胱氨酸(Hcy)水平,及不良反应。结果 治疗后,治疗组患者临床有效率为98.33%,明显高于对照组(81.67%,P<0.05)。治疗后,治疗组临床症状缓解时间均早于对照组(P<0.05)。治疗后,两组患者的Barthel指数评分明显升高,而NIHSS评分明显降低(P<0.05),且治疗组Barthel指数和NIHSS评分明显好于对照组(P<0.05)。治疗后,两组患者血清炎性因子IL-6、NSE、TNF-α、Hcy水平明显降低(P<0.05),且治疗组明显低于对照组(P<0.05)。治疗后,治疗组不良反应总发生率为6.67%,明显低于对照组发生率(15.00%,P<0.05)。结论 阿替普酶联合蛭蛇通络胶囊治疗效果确切,可缓解急性脑梗死症状,患者神经功能损伤程度改善明显,患者自理能力增强,并能降低机体炎性因子。

Objective To investigate the clinical efficacy of Zhishe Tongluo Capsules combined with ateplase in treatment of acute cerebral infarction.Methods Patients(120 cases) with acute cerebral infarction in Dingzhou People's Hospital from November 2019 to June 2022 were randomly divided into control(60 cases) and treatment(60 cases) group. Patients in the control group was iv administered with Alteplase for injection, 0.9 mg/kg, the maximum dose was no more than 90 mg, 10% of which was injected intravenously within 1 min, and the remaining drugs were pumped within 1 h. Patients in the treatment group were po administered with Zhishe Tongluo Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the relief time of symptom, the scores of Barthel index and NIHSS,levels of inflammatory factors IL-6, NSE, TNF-α, and Hcy, adverse reactions in two groups before and after treatment were compared.Results After treatment, the clinical effective rate of the treatment group was 98.33%, which was significantly higher than that of the control group(81.67%, P<0.05). After treatment, the relief time of clinical symptoms in the treatment group was earlier than that in the control group(P<0.05). After treatment, the Barthel index score in the two groups were significantly increased, while the NIHSS score were significantly decreased(P<0.05), and the Barthel index and NIHSS score in the treatment group were significantly better than those in the control group(P<0.05). After treatment, the levels of serum inflammatory factors IL-6, NSE, TNF-α and Hcy in two groups were significantly decreased(P<0.05), and the level in the treatment group was significantly lower than that in the control group(P<0.05). After treatment, the total incidence of adverse reactions in the treatment group was 6.67%, which was significantly lower than that in the control group(15.00%, P<0.05).Conclusion Ateplase combined with Zhishe Tongluo Capsules has a definite therapeutic effect, which can effectively relieve the symptoms of acute cerebral infarction, improve the degree of neurological injury, enhance the self-care ability and reduce the reaction of inflammatory factors.

R971

河北省中医药管理局科研项目(2019358)