丁苯酞注射液联合血塞通注射液治疗急性脑梗死的MRI灌注成像影像学评价

MRI Perfusion Imaging Evaluation of Butylphthalide Injection Combined with Xuesaitong Injection in The Treatment of Acute Cerebral Infarction

目的:观察丁苯酞注射液联合血塞通注射液治疗急性脑梗死的临床疗效,同时采用MRI灌注成像从影像学角度进行疗效评价。方法:将符合纳入标准的80例急性脑梗死病人按随机数字表法随机分为对照组与治疗组,各40例。两组患者入院后均按照临床路径开展治疗,均给予降压、降糖、调脂、营养神经、抗血小板聚集等药物。对照组在此基础上联合应用丁苯酞氯化钠注射液100 mL静脉滴注治疗,观察组则在对照组基础上联合血塞通注射液200 mg加入5%葡萄糖注射液250 mL静脉滴注。对比两组患者入院当天、分组治疗10 d后的美国国立卫生研究院卒中量表(The National Institutes of Health Stroke Scale,NIHSS)评分、日常生活能力Barthel指数(Barthel Index,BI)评分以及给予MRI灌注成像相关指标变化。结果:治疗组治疗总有效率明显高于对照组(97.50%vs 77.50%,P<0.05);治疗后,两组NIHSS评分均较治疗前下降,BI评分均较治疗前上升,差异有统计学意义(P<0.05),且治疗组优于对照组(P<0.05);治疗后,两组感兴趣区的衰减指数均明显降低,平均扩散系数明显升高(P<0.05),且治疗组数据均明显优于对照组(P<0.05);分组治疗后,治疗组患者的脑血容量、脑血流量均明显优于对照组(P<0.05);基于Pearson相关性分析可知,治疗组治疗后平均扩散系数(r=-0.503,r=0.482)、衰减指数(r=-0.487,r=0.414)、脑血容量(r=-0.527,r=0.402)及脑血流量(r=-0.625,r=0.516)与NIHSS评分和BI评分均有显著相关性(P<0.05)。结论:基于多模态MRI成像结果可证实丁苯酞注射液联合血塞通注射液治疗急性脑梗死的效果良好,展现治疗前后病灶区域平均扩散系数和衰减指数的差异变化,直观反映容积比各向异性和部分各向异性的变化以及脑血流量和脑血容量的改善,且上述指标的变化与急性脑梗死患者的神经功能缺损程度和日常生活能力变化的相关性良好,提示多模态MRI成像结果可作为急性脑梗死的疗效评价提供可靠参考。

Objective:To observe the clinical efficacy of butylphthalide injection combined with Xuesaitong Injection in the treatment of acute cerebral infarction,and to evaluate the efficacy from the perspective of MRI perfusion imaging.Methods:80 patients with acute cerebral infarction who met the inclusion criteria were randomly divided into control group and treatment group according to the random number table method,40 cases in each group.After admission,the patients in both groups were treated according to the clinical pathway,and were given drugs such as antihypertensive,hypoglycemic,lipid-lowering,neurotrophic,and antiplatelet aggregation.The control group was treated with butylphthalide sodium chloride injection 100 mL intravenous drip on this basis,while the observation group was treated with Xuesaitong injection 200 mg and 5%glucose injection 250 mL intravenous drip on the basis of the control group.The National Institutes of Health Stroke Scale(NIHSS)score,Barthel Index(BI)of activities of daily living score and MRI perfusion imaging related indicators were compared between the two groups on the day of admission and 10 days after treatment.Results:The total effective rate of the treatment group was significantly higher than that of the control group(97.50%vs 77.50%,P<0.05);After treatment,the NIHSS score of the two groups decreased and the Bi score increased compared with that before treatment,and the difference was statistically significant(P<0.05),and the treatment group was better than the control group(P<0.05);After treatment,the attenuation index of the region of interest in both groups was significantly reduced,and the average diffusion coefficient was significantly increased(P<0.05),and the data of the treatment group were significantly better than those of the control group(P<0.05);After grouping treatment,the cerebral blood volume and cerebral bloodflow of the treatment group were significantly better than those of the control group(P<0.05);According to Pearson correlation analysis,the average diffusion coefficient(r=-0.503,r=0.482),attenuation index(r=-0.487,r=0.414),cerebral blood volume(r=-0.527,r=0.402)and cerebral blood flow(r=-0.625,r=0.516)in the treatment group after treatment were significantly correlated with NIHSS score and Bi score(P<0.05).Conclusion:Based on the results of multimodal MRI imaging,it can confirm the good effect of butylphthalide injection combined with Xuesaitong Injection in the treatment of acute cerebral infarction,show the difference changes of average diffusion coefficient and attenuation index in the lesion area before and after treatment,intuitively reflect the changes of volume ratio anisotropy and partial anisotropy,as well as the improvement of cerebral bloodflow and cerebral blood volume,and the changes of the above indicators have a good correlation with the degree of neurological deficit and the changes of daily living ability in patients with acute cerebral infarction,suggesting that the results of multimodal MRI imaging can provide a reliable reference for the evaluation of the curative effect of acute cerebral infarction.