丹红注射液联合阿替普酶治疗不同分型急性脑梗死的疗效观察

Clinical observation of Danhong Injection combined with alteplase in treatment of different types of acute cerebral infarction

目的探讨丹红注射液联合阿替普酶治疗不同分型急性脑梗死的临床疗效。方法选取2013年4月—2015年3月榆林市第二医院和西安交通大学第二附属医院的急性脑梗死患者72例,随机分为对照组和治疗组,每组各36例。对照组给予注射用阿替普酶,0.9 mg/kg,10%静脉推注,90%静脉滴注,1 h内滴注完毕,最大剂量不超过90 mg。治疗组在对照组基础上静脉滴注丹红注射液,20 m L加入到生理盐水250 m L,1次/d。两组患者治疗2周。观察两组的临床疗效,比较两组溶栓前后多普勒超声(TCD)参数、TCD血流分型、神经功能缺损症状量表(NIHSS)评分、Rankin表(m RS)评分的变化。结果治疗后,对照组和治疗组完全闭塞型总有效率分别为66.67%、83.33%,部分闭塞型总有效率分别为81.82%、90.00%,非闭塞型总有效率分别为94.74%、95.00%,两组比较差异无统计学意义。溶栓后,两组完全闭塞、部分闭塞患者收缩期血流速度(Vs)、平均血流速(Vm)、舒张期血流速(Vd)均上升,搏动指数(PI)下降,同组溶栓前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组完全闭塞、部分闭塞比例下降,非闭塞型比例上升,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗1、2周后,两组完全闭塞、部分闭塞、非闭塞患者NIHSS评分均降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的降低程度明显优于同期对照组,两组比较差异具有统计学意义(P<0.05)。治疗后3个月,治疗组部分闭塞和非闭塞患者m RS评分显著下降,同类型治疗前后比较差异有统计学意义(P<0.05);且治疗组非闭塞患者m RS评分明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论丹红注射液联合阿替普酶治疗不同分型急性脑梗死具有较好临床疗效,可改善患者脑功能,促进闭塞血管再通,改善血流动力学,有益于短期预后,安全性好,具有一定的临床推广应用价值。

Objective To explore the clinical effect of Danhong Injection combined with alteplase in treatment of different types of acute cerebral infarction. Methods Patients （72 cases） with acute cerebral infarction in Yulin Second Hospital and the Second Affiliated Hospital of Xi’an Jiaotong University from April 2013 to March 2015 were randomly divided into control and treatment groups, and each group had 36 cases. Patients in the control group were iv administered with Alteplase for injection, 0.9 mg/kg, 10%iv bolus injection, 90%iv drip, the infusion is completed within 1 h, and the maximum dose is not more than 90 mg. Patients in the treatment group were iv administered with Danhong Injection on the basis of the control group, 20 mL added into normal saline 250 mL, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and TCD parameters, TCD blood flow typing, NIHSS scores, and mRS scores in two groups were compared. Results After treatment, the clinical efficacies in the total, partial, and non-occlusion types of the control group were 66.67%, 81.82%, and 94.74%, respectively,and those of the treatment group were 83.33%, 90.00%, and 95.00%, respectively, and there was no difference between two groups. After thrombolysis, Vs, Vm, and Vd in the total and partial occlusion type of the control and treatment groups were increased, but PI in the total and partial occlusion type of the control and treatment groups were decreased, and the difference was statistically significant in the same group （P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups （P〈0.05）. After treatment, the proportion of the total and partial occlusion type of the control and treatment groups was decreased, but the proportion of the non-occlusion type of the control and treatment groups was increased, and the difference was statistically significant in the same group （P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups （P〈0.05）. After the first and second week treatment, the NIHSS scores of the total, partial, and non-occlusion type of the control and treatment groups were decrease, and the difference was statistically significant in the same group （P〈0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P〈0.05）. After 3 months treatment, the mRS scores of the partial and non-occlusion type of the treatment group were significantly decreased, and the difference was statistically significant in the same type （P〈0.05）. And the mRS score of the non-occlusion type of the treatment group were significantly lower than that in the control group, with significant difference between two groups （P 〈 0.05）. Conclusion Danhong Injection combined with alteplase has clinical curative effect in treatment of different types of acute cerebral infarction, and can improve brain function, promote occluded vessels recanalization, improve hemodynamics, which is beneficial to short-term prognosis, with good safety, which has a certain clinical application value.