杏芎氯化钠注射液联合氯吡格雷治疗脑梗死的临床研究

Clinical study on Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection combined with clopidogrel in treatment of cerebral infarction

目的探讨杏芎氯化钠注射液联合硫酸氢氯吡格雷片治疗脑梗死临床疗效。方法选取2018年10月—2019年4月在延安大学咸阳医院治疗的脑梗死患者206例,根据用药的差别分为对照组(103例)和治疗组(103例)。对照组口服硫酸氢氯吡格雷片,75 mg/次,1次/d;治疗组在对照组基础上静脉滴注杏芎氯化钠注射液,100 m L/次,1次/d。两组患者均治疗15d。观察两组患者临床疗效,同时比较治疗前后两组患者NIHSS评分、m RS评分、ESRS评分、SPI-Ⅱ评分、ADL评分、脑血流动力学,血清C反应蛋白(CPP)、白细胞介素-17(IL-17)、CXC趋化因子配体12(CXCL12)、白细胞介素-23(IL-23)、单核细胞趋化蛋白-1(MCP-1)和可溶性血管细胞黏附因子-1(s VCAM-1)水平,及血管储备功能(CVR),屏气指数(BHI)、纤维蛋白原(FIB)、全血低切黏度(LBV)、全血高切黏度(HBV)、血浆黏度(SV)和血小板聚集率(PAR)。结果治疗后,对照组和治疗组临床有效率分别为82.52%和97.09%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者NIHSS评分、m RS评分、ESRS评分和SPI-Ⅱ评分显著下降(P<0.05),而ADL评分显著升高(P<0.05),且治疗组患者这些评分项目明显好于对照组(P<0.05)。治疗后,两组患者血清CPP、IL-17、CXCL12、IL-23、MCP-1、s VCAM-1水平均显著下降(P<0.05),且治疗组比对照组下降更明显(P<0.05)。治疗后,两组双侧大脑动脉Vp、Vm均显著升高(P<0.05),DVp和DVm显著降低(P<0.05),且治疗组改善程度最明显(P<0.05)。治疗后,两组患者CVR、BHI均明显升高(P<0.05),且以治疗组比对照组升高更显著(P<0.05)。治疗后,两组患者FIB、LBV、HBV、SV、PAR水平均显著降低(P<0.05),且治疗组这些血液流变学指标水平明显低于对照组(P<0.05)。结论杏芎氯化钠注射液联合硫酸氢氯吡格雷片治疗脑梗死有利于促进患者脑神经功能恢复,提高患者生活质量、日常活动能力和降低脑血管事件发生风险。

Objective To investigate the clinical effect of Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection combined with clopidogrel in treatment of ischemic cerebral infarction.Methods Patients(206 cases)with ischemic cerebral infarction in Xianyang Hospital of Yan’an University from October 2018 to April 2019 were divided into control(60 cases)and treatment(60 cases)groups based on different treatments.Patients in the control group were po administered with Clopidogrel Hydrogen Sulphate Tablets,75 mg/time,once daily.Patients in the treatment group were iv administered with Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection on the basis of the control group,100 m L/time,once daily.Patients in two groups were treated for 15 d.After treatment,the clinical efficacy was evaluated,and the NIHSS scores,m RS scores,ESRS scores,SPI-Ⅱscores,ADL scores,cerebral hemodynamic,the serum levels of CPP,IL-17,CXCL12,IL-23,MCP-1,s VCAM-1,and CVR,BHI,FIB,LBV,HBV,SV and PAR in two groups before and after treatment were compared.Results After treatment,the clinical efficacy and i n the controland treatment groups was 82.52%and 97.09%,respectively,and there were differences between two groups(P<0.05).After treatment,the NIHSS scores,m RS scores,ESRS scores,and SPI-Ⅱscores in two groups were significantly decreased(P<0.05),but the ADL scores were significantly increased(P<0.05),and these scores in the treatment group were significantly better than those in the control group(P<0.05).After treatment,the serum levels of CPP,IL-17,CXCL12,IL-23,MCP-1,and s VCAM-1 in two groups were significantly decreased(P<0.05),and these serological indexes in the treatment group were significantly lower than those in the control group(P<0.05).After treatment,the Vp and Vm of bilateral cerebral arteries in two groups were significantly increased(P<0.05),but the value of DVp and DVm was significantly decreased(P<0.05),and the hemodynamic parameters in the treatment group were significantly better than those in the control group(P<0.05).After treatment,the CVR and BHI in two groups were significantly increased(P<0.05),and which in the treatment group were significantly higher than those in the control group(P<0.05).After treatment,the FIB,LBV,HBV,SV,and PAR levels in two groups were significantly decreased(P<0.05),and these indexes in the treatment group were significantly lower than those in the control group(P<0.05).Conclusion Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride Injection combined with clopidogrel in treatment of ischemic cerebral infarction is beneficial to promote the recovery of cerebral nerve function,improve the quality of life,daily activity ability and reducing the risk of cerebrovascular events.