丁苯酞联合阿替普酶治疗急性脑梗死的疗效观察

Clinical observation of butylphthalide combined with alteplase in treatment of acute ischemic stroke

目的探讨丁苯酞氯化钠注射液联合注射用阿替普酶治疗急性脑梗死的临床效果。方法选取2015年8月—2017年5月在武汉市武昌医院进行治疗的急性脑梗死患者72例为研究对象,将患者随机分为对照组和治疗组,每组各36例。对照组在脑部血栓内给予注射用阿替普酶,0.3 mg/kg,总量不超过20 mg。治疗组在对照组的基础上静脉注射丁苯酞氯化钠注射液,25 mg/次,2次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组的美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数量表(BI)评分、改良Rankin评分量表(m RS)评分和预后情况。结果治疗后,对照组和治疗组的总有效率分别为77.80%、94.40%,两组比较差异有统计学意义(P<0.05)。治疗7、14 d后,两组NIHSS评分明显降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组NIHSS评分明显低于同期对照组,两组比较差异具有统计学意义(P<0.05)。治疗后30 d,对照组和治疗组BI评分优良率分别44.4%、69.4%,两组比较差异具有统计学意义(P<0.05);治疗后90 d,对照组和治疗组m RS评分良好率分别为50.0%、75.0%,两组比较差异有统计学意义(P<0.05)。治疗后90 d,对照组和治疗组再发脑梗死率分别为33.3%、8.3%,对照组和治疗组再发脑出血率分别为25.0%、5.6%,两组比较差异有统计学意义(P<0.05)。结论丁苯酞氯化钠注射液联合注射用阿替普酶治疗急性脑梗死具有较好的临床疗效,能改善神经功能,提高生活质量,减少再出血率、再梗死率,具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Butylphthalide and Sodium Chloride Injection combined with Alteplase for injection in treatment of acute ischemic stroke. Methods Patients （72 cases） with acute ischemic stroke in Wuhan Wuchang Hospital from August 2015 to May 2017 were randomly divided into control and treatment groups, and each group had 36 cases. Patients in the control group were given Alteplase for injection into the brain thrombus, 0.3 mg/kg, and total amount was not more than 20 mg. Patients in the treatment group were iv administered with Butylphthalide and Sodium Chloride Injection on the basis of the control group, 25 mg/time, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and NIHSS score, BI score, mRS score, and prognosis in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.80% and 94.40%, respectively, and there was difference between two groups （P 〈0.05）. After treatment 7 and 14 d, the NIHSS scores in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the NIHSS score in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P 〈 0.05）. After treatment for 30 d, the excellent rates of BI score in the control and treatment groups were 44.4% and 69.4%, respectively, and there was difference between two groups （P 〈 0.05）. After treatment for 90 d, the good rates of mRS score in the control and treatment groups were 50.0% and 75.0%, respectively, and there was difference between two groups （P 〈0.05）. After treatment for 90 d, the recurrent cerebral infarction rates in the control and treatment groups were 33.3% and 8.3%, respectively, the recurrent cerebral hemorrhage rates in the control and treatment groups were 25.0% and 5.6%, respectively, and there was difference between two groups （P 〈 0.05）. Conclusion Butylphthalide and Sodium Chloride Injection combined with Alteplase for injection has clinical curative effect in treatment of acute ischemic stroke, can improve the nerve function, enhance the quality of life, reduce the recurrent cerebral hemorrhage rate and recurrent cerebral infarction rate, which has a certain clinical application value.