阿替普酶联合小续命汤治疗溶栓时间窗外急性脑梗死疗效观察

Observation of Therapeutic Effect on Acute Cerebral Infarction out of the Time Window Treated by Alteplase Combined with Xiaoxuming Decoction

目的:观察阿替普酶联合小续命汤治疗溶栓时间窗外急性脑梗死的临床疗效。方法:80例随机分为观察组和对照组各40例。两组均根据病情选用抗凝、抗血小板、调节血脂、调控血压及调节血糖等基础治疗。对照组加基阿替普酶,观察组在对照组基础上加用小续命汤治疗。治疗14天评价疗效,用CT灌注成像检测梗死中心及其周围区域组织灌注情况,用经颅多普勒诊断仪测定双侧大脑中动脉(MCA)的峰流速(Vp)、平均流速(Vm),检测血清神经元特异性烯醇化酶(NSE)水平,通过NIHSS评分评估治疗前后神经功能。结果:观察组梗死中心及其周围区域组织灌注情况得到明显改善,且治疗后改善程度优于对照组(P<0.05);观察组Vp、Vm均升高,血清NSE水平、NIHSS评分均较治疗后降低(P<0.05);且治疗后于对照组(P<0.05)。结论:阿替普酶联合小续命汤治疗溶栓时间窗外急性脑梗死能够明显改善梗死中心及其周围区域组织灌注,尤其对梗死周围组织灌注的改善更为明显,同时能够明显改善脑动脉供血和血流动力学,促进神经功能恢复。

Objective： To observe the clinical therapeutic effect of Alteplase combined with Xiaoxuming Decoction in the treatment of acute cerebral infarction out of thrombolytic time window. Method： 80 patients were randomly divided into observation group and control group, 40 cases in each group. All the patients were treated with anticoagulation, anti-platelets, regulation of blood lipids, regulation of blood pressure and regulation of blood glucose according to the concrete condition. The control group were treated with alteplase in addition while the observation group were treated with Xiaoxuming Decoction based on the treatment of the control group. After 14 days of treatment, the curative effect of the two groups of patients was measured. CT perfusion imaging was used to detect the perfusion of the infarcted center and its surrounding area. The peak flow velocity （ Vp ） and mean flow velocity （ Vm ） of the middle cerebral artery （ MCA ） was measured by transcranial Doppler diagnostic apparatuswere. Serum neuron- specific enolase （ NSE ） levels were measured and the neurological function was evaluated by NIHSS score before and after treatment. Result： After treatment, the perfilsion of the infarct center and its surrounding area was significantly improved in the observation group and the improvement degree was superior to that of the control group （ P 〈 0.05 ） .The level of Vp and Vm in the observation group after the treatment was significantly higher than that before the treatment and the improvement was superior to that in the control group （ P 〈 0.05 ） .The level of serum NSE and the NIHSS score of the observation group significantly decreased after the treatment and was lower than that in the control group （ P 〈 0.05 ） .Conclusion： Alteplase combined with Xiaoxuming Decoction could sigrfificantly improve the infusion of the infarct center and its surrounding area in patients with acute cerebral infarction, especially in the infusion of infarcted tissue. At the same time, it could improve the acute cerebral infarction patients with cerebral arterial blood supply and hemodynamics, to promote nerve function recovery.