经颅多普勒监测评估疏血通对急性缺血性脑卒中患者颅内微栓子的干预作用

Evaluation of shuxuetong by transcranial Doppler for intervention of intracranial microemboli in patients with acute ischemic stroke

目的:通过经颅多普勒(TCD)自动监测微栓子信号(microembolicsignal,MES),研究疏血通注射液对急性缺血性脑卒中患者颅内微栓子的干预作用。方法:入院即时予德国DWL-Embo-dop型TCD监测MES,并对MES自动分析与计数,分为阳性、阴性两大组,两组再各随机分为常规治疗组、疏血通注射液治疗组,并分别于第2,5,7,10,15,20天监测TCD。结果:入院MES阳性组中,疏血通注射液治疗组20例,至第15天有19例MES消失,而对照组18例至第20天时仅有7例MES消失,两组MES消失的概率比较,差异有非常显著性意义(χ2=16.35,P<0.01);入院MES阴性组中,疏血通注射液治疗组至第20天有13例次出现MES,而对照组至第20天有32例次出现MES,两组MES出现的概率差异有显著性意义(χ2=13.08,P<0.05);疏血通注射液的抑栓作用在使用第5天即出现,于第7天达高峰,至第10,15天继续作用;但停药5d后有MES复现的现象。结论:疏血通注射液对急性缺血性脑卒中的微栓子具有预防和治疗作用;TCD栓子自动监测有助于及时发现微栓子、评估药物疗效。

AIM:To monitor microembolic signal(MES) with transcranial Doppler(TCD) automatically,so as to study the intervention effect of shuxuetong injection on the intracranial MES in patients with acute ischemic stroke. METHODS:After MES was automatically monitored,analysed and counted by TCD of German DWL Embo dop type as soon as admission,all the patients were divided into positive group and negative group,which were then randomly divided into two subgroups respectively:normal therapy group and shuxuetong injection treatment group. All the patients were monitored with TCD at the 2nd,5th,7th,10th,15th and 20th day. RESULTS:In the positive group,the MES of 19 patients out of the 20 patients in shuxuetong injection treatment group disappeared at the 15th day, while that of only 7 patients out of the 18 patients in the control group disappeared at the 20th day. The probability of MES in shuxuetong injection treatment group was significantly different from that in the control group(χ2=16.35,P< 0.01);while in negative group:the MES of 13 patients appeared in shuxue tong injection treatment group at the 20th day,while that of 32 patients in the control group appeared at the 20th day(χ2=13.08,P< 0.05); On the 5th day,embolus inhibited effect appeared by shuxuetong injection, reached the peak in the 7th day and kept on the 10th and the 15th day,but MES could recur after 5 days without shuxuetong injection. CONCLUSION:Shuxuetong injection has preventive and therapeutic effects on MES of AIS,TCD automatic embolus monitor helps to find MES in time and evaluate the effect of drugs.