前列地尔联合阿替普酶治疗急性脑梗死的疗效观察

Clinical observation of alprostadil combined with alteplase in treatment of acute cerebral infarction

目的观察前列地尔联合阿替普酶治疗急性脑梗死的临床疗效。方法选择2011年12月—2015年4月烟台龙矿中心医院收治的急性脑梗死患者120例,随机分成对照组和治疗组,每组各60例。对照组给予注射用阿替普酶,5 mg溶于10 mL生理盐水中,10 s内静脉推注,45 mg溶于100 mL生理盐水中,60 min内静脉滴注。治疗组在对照组的基础上静脉滴注前列地尔注射液,20μg溶于250 mL生理盐水,1次/d,两组患者均连续治疗14 d。观察两组的临床疗效,比较两组治疗前后国立卫生研究院卒中量表(NIHSS)评分、日常生活能力指数(BI)、血管再通情况和脑梗死灶体积。结果治疗后,对照组和治疗组总有效率分别为86.67%、93.33%,两组总有效率比较差异具有统计学意义(P<0.05)。两组患者的NIHSS评分较治疗前明显下降,BI评分较治疗前明显升高,同组治疗前后差异有统计学意义(P<0.05);且治疗组NIHSS评分和BI评分的改善程度优于对照组,两组比较差异有统计学意义(P<0.05)。两组血管再通情况比较差异无统计学意义。两组患者的脑梗死灶体积均较治疗前明显缩小,同组治疗前后差异有统计学意义(P<0.05);且治疗组的治疗前后差明显大于对照组(P<0.05)。结论前列地尔联合阿替普酶治疗急性脑梗死疗效显著,能够显著改善患者的神经功能缺损症状,提高日常生活活动能力,具有一定的临床推广应用价值。

Objective To observe the clinical effect of alprostadil combined with alteplase in treatment of acute cerebral infarction. Methods Patients（120 cases） with acute cerebral infarction in Yantai Longkuang Central Hospital from December 2011 to Apirl 2015 were selected. The patients were randomly divided into control group and treatment group, and each group had 60 cases. Patients in the control group were given Alteplase for injection, 5 mg added into 10 mL normal saline, within 10 s for iv injection, and 45 mg added into 100 mL normal saline, within 60 min for iv drip. The patients in treatment group were iv administered with Alprostadil Injection on the basis of the control group, 20 μg added into 250 mL normal saline, once daily. The patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and National Institute of Health stroke scale（NIHSS） scores, Barthel index（BI）, vascular recanalization, and cerebral infarction size before and after treatment in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 86.67% and 93.33%, respectively, and there were differences between two groups（P〈 0.05）. After treatment, NIHSS scores in two groups were significantly decreased, but BI scores were significantly increased, and the differences were statistically significant in the same group（P〈 0.05）. After treatment, the NIHSS and BI scores in the treatment group were significantly better than those in the control group, and there were significant differences between two groups（P〈 0.05）. There was no significant difference in vascular recanalization between two groups. Cerebral infarction size in two groups were significantly decreased, and the differences were statistically significant in the same group（P〈 0.05）. After treatment, the difference value of cerebral infarction size in the treatment group was significantly better than those in the control group with significant differences（P〈 0.05）. Conclusion Alprostadil combined with alteplase has clinical curative effect in treatment of acute cerebral infarction, and can significantly improve nerve function, and increase ability of daily life, which has a certain clinical application value.