灯盏花素联合奥扎格雷钠治疗短暂性脑缺血发作患者的疗效及其对血液流变学的影响

Changes in blood rheology of patients with transient ischemic attack in treatment with breviscapine and thromboxane synthetase inhibitors

目的观察应用灯盏花素与奥扎格雷钠联合治疗短暂性脑缺血发作患者的临床效果及对血液流变学指标的影响。方法选取2015年1月—2016年1月唐山市协和医院神经内二科收治的短暂性脑缺血发作患者124例作为研究对象,按随机数字表法分为2组,每组62例。2组患者入院后均给予低分子肝素、阿司匹林、吸氧、预防感染等常规基础治疗。对照组在常规治疗基础上给予注射用奥扎格雷钠100 mg静脉滴注,每天1次;观察组在对照组基础上联合应用灯盏花素注射液40 mg静脉滴注,每天1次,2组患者疗程均为2周。比较2组患者临床疗效及治疗前后血液流变学、血流动力学、血小板活性指标水平变化情况,观察不良反应发生情况。结果治疗后观察组总有效率为91.9%（57/62）,明显高于对照组的79.0%（49/62）,差异有统计学意义（χ~2=4.159,P〈0.05）;与治疗前比较,治疗后2组全血黏度高切、全血黏度低切、纤维蛋白原、血浆黏度、血小板聚集率、PAF、GMP-140水平均显著降低,峰流速、平均流速、峰流速差值、平均峰流速差值等指标均显著改善,且2组间比较差异具有统计学意义（t=13.587、3.556、7.704、4.317、7.419、4.001、6.384、6.507、5.829、12.130、6.866,P〈0.05）;观察组TLA再发作、局灶性神经功能缺损、心血管事件发生率均明显低于对照组（χ~2=4.578、6.356、4.918,P〈0.05）。结论灯盏花素与奥扎格雷钠联合治疗短暂性脑缺血发作疗效确切,有效改善血液流变学指标,安全可靠,有利改善患者预后。

Objective To observe the clinical effect of the application of Breviscapine injection and ozagrel sodium combination therapy in patients with transient ischemic attack and influence on hemorheological indexes of hemorheology.Methods 124 cases of transient ischemic attack were selected from Department of Neurology,Tangshan City Union Hospital from January 201 S to January 2016 as the study subjects,according to the random number table method were divided into 2groups,each group of 62 cases.2 groups of patients were given low molecular weight heparin,aspirin,oxygen inhalation,prevention of infection and other conventional basic treatment.The control group on the basis of routine treatment,added Ozagrel Sodium Injection 100 mg,1 times a day;the observation group also added Breviscapine Injection 40 mg,1 times a day,2 groups were treated for 2 weeks.The clinical effect and the changes of blood rheology,hemodynamics and blood platelet activity index were compared between the 2 groups before and after treatment.Results After the treatment in observation group,the total effective rate was 91.9%（57/62）,which significantly higher than the control group of 79.0%（49/62）,the difference was statistically significant（χ~2=4.159,P 0.05）;compared with before treatment,after treatment in the 2 group,the whole blood viscosity,whole blood viscosity at low shear,fibrinogen,plasma viscosity,platelet aggregation rate and platelet activating factor（PAF）,GMP-140 and peak velocity,mean velocity and velocity difference of peak,mean peak flow velocity difference indicators were significantly improve,and between the two groups,the difference has statistical significance（t =13.587,t =3.556,t =7.704,t =4.317,t=7.419,t =4.001,t =6.384,t =6.507,t =5.829,t =12.130,t =6.866,P 0.05）;observation groups TIA attack,focal neurological,cardiovascular event rates were significantly lower than those in the control group（χ~2 =4.578,χ~2 =6.356,χ~2 =4.918,P 0.05）.Conclusion Breviscapine injection and ozagrel sodium combination therapy for treatment of transient ischemic attack has curative effect,effectively improve the indexes of blood rheology,safe and reliable,favorable improve the prognosis of the patients.