[关键词]
[摘要]
目的 探讨丹灯通脑胶囊联合丁苯酞治疗急性脑梗死的临床效果。方法 选取2018年8月-2020年7月南阳市中心医院收治的86例急性脑梗死患者,按照治疗方法将患者分成对照组(n=43)和观察组(n=43)。对照组静脉滴注丁苯酞氯化钠注射液,25 mg/次,每次滴注时间≥ 50 min,2次/d(用药时间间隔≥ 6 h)。观察组在对照组基础上口服丹灯通脑胶囊,1.4 g/次,3次/d。两组均连续治疗14 d。比较两组临床疗效及安全性,观察两组治疗前后脑卒中自我效能问卷(SSEQ)评分、美国国立卫生研究院卒中量表(NIHSS)评分、大脑中动脉血流动力学参数[平均血流速度(Vm)、阻力指数(RI)]及血浆D-二聚体(D-D)、纤维蛋白原(FIB)水平和血清血管内皮生长因子(VEGF)、血管性血友病因子(vWF)、多胺氧化酶(PAO)、金属基质蛋白酶(MMP)-9水平变化,并进行统计分析。结果 治疗后,观察组总有效率为93.0%,较对照组的76.7%显著升高(P<0.05)。两组治疗后SSEQ评分均显著增高,NIHSS评分则均显著降低(P<0.05);且治疗后,观察组SSEQ评分显著高于对照组,NIHSS评分显著低于对照组(P<0.05)。治疗后,两组大脑中动脉Vm较同组治疗前均显著增加,大脑中动脉RI及血浆FIB、D-D水平均较本组治疗前显著降低(P<0.05);且与同期对照组比较,观察组治疗后大脑中动脉Vm显著更高,大脑中动脉RI及血浆FIB、D-D水平均显著更低(P<0.05)。两组治疗后血清VEGF、vWF、PAO及MMP-9水平均较本组治疗前显著下降(P<0.05);且治疗后,观察组比对照组对血清VEGF、vWF、PAO和MMP-9水平的降低作用更显著(P<0.05)。结论 丹灯通脑胶囊联合丁苯酞治疗急性脑梗死的整体疗效显著,能安全有效地改善患者脑血流动力学状态,抑制血栓形成,减轻血管内皮损伤,保护神经功能,提高患者生活质量,值得临床推广。
[Key word]
[Abstract]
Objective To investigate the clinical effect of Dandeng Tongnao Capsules combined with butylphthalide in treatment of acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted to Nanyang Central Hospital from August 2018 to July 2020 were selected, and the patients were divided into control group (n=43) and observation group (n=43) according to treatment methods. Patients in the control group were iv administered with Butylphthalide and Sodium Chloride Injection, 25 mg/time, each infusion time ≥ 50 min, twice daily (medication time interval ≥ 6 h). Patients in the observation group were po administered with Dandeng Tongnao Capsule on the basis of control group, 1.4 g/time, three times daily. Both groups were treated continuously for 14 d. Clinical efficacy and safety of two groups were compared. Observe of SSEQ scores, NIHSS score, arterial blood flow in the brain mechanics parameters (Vm, RI) and plasma D-D, FIB levels, and serum VEGF, vWF, PAO, and MMP-9 before and after the treatment between two groups were analyzed statistically. Results After treatment, the total effective rate of the observation group was 93.0%, which was significantly higher than 76.7% of the control group (P<0.05). After treatment, SSEQ score in two groups was significantly increased, while NIHSS score was significantly decreased (P<0.05). After treatment, the SSEQ score in the observation group was significantly higher than that in the control group, and the NIHSS score was significantly lower than that in the control group (P<0.05). After treatment, Vm of middle cerebral artery in two groups was significantly increased compared with before treatment, but RI of middle cerebral artery, plasma FIB and D-D levels were significantly decreased compared with before treatment (P<0.05). Moreover, compared with the control group at the same period, Vm of middle cerebral artery in the observation group was significantly higher after treatment, RI of middle cerebral artery, plasma FIB and D-D levels were significantly lower (P<0.05). After treatment, the levels of serum VEGF, vWF, PAO, and MMP-9 in two groups were significantly decreased compared with before treatment (P<0.05). After treatment, the observation group had more significant effect on the decrease of serum VEGF, vWF, PAO and MMP-9 levels than the control group (P<0.05). Conclusion Dandeng Tongnao Capsules combined with butylphthalide in treatment of acute cerebral infarction is significant, which can safely and effectively improve the state of cerebral hemodynamics, inhibit thrombosis, reduce vascular endothelial injury, protect neurological function, and improve the quality of life of patients, which is worthy of clinical promotion.
[中图分类号]
R971
[基金项目]
南阳市卫生和计划生育委员会科研项目(ZD201778)