脑蛋白水解物联合尿激酶治疗急性脑梗死的临床研究

Clinical study on cerebroprotein hydrolysate combined with urokinase in treatment of acute cerebral infarction

目的探讨脑蛋白水解物注射液联合尿激酶治疗急性脑梗死的临床疗效。方法选取2015年1月—2017年8月在安徽医科大学附属巢湖医院治疗的急性脑梗死患者94例,随机分为对照组(47例)和治疗组(47例)。对照组静脉滴注注射用尿激酶,100万单位加入150 m L生理盐水,30 min内滴完,入院后1次;治疗组在对照组的基础上静脉滴注注射用脑蛋白水解物,10 m L加入250 m L生理盐水,1次/d。两组均经过14 d治疗。观察两组患者临床疗效,比较治疗前后两组患者NIHSS评分、SF-36量表评分、血清学指标和脑血流动力学指标。结果治疗后,对照组临床总有效率为80.85%,显著低于治疗组的95.74%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组NIHSS评分明显降低、SF-36量表各项目评分明显升高,同组比较差异具有统计学意义(P<0.05);且治疗组上述评分改善后水平明显优于对照组(P<0.05)。治疗后,两组患者血清基质金属蛋白酶-9(MMP-9)、白细胞分化抗原40(CD40L)、氧化低密度脂蛋白和胱抑素C(Cys C)均明显降低(P<0.05);且治疗组上述血清学指标明显低于对照组(P<0.05)。治疗后,两组患者平均血流量(Q_(mean))和平均血流速度(V_(mean))水平明显升高,动态阻抗(DR)、脑血管特征性阻抗(ZCV)和脑血管外周阻力(R)水平明显降低,同组比较差异具有统计学意义(P<0.05);且治疗组上述脑血流动力学指标水平显著优于对照组(P<0.05)。结论脑蛋白水解物联合尿激酶治疗急性脑梗死可有效降低机体炎性反应,促进神经功能恢复,改善脑血流动力学。

Objective To investigate the efficacy of cerebroprotein hydrolysate combined with urokinase in treatment of acute cerebral infarction.Methods Patients（94 cases）with acute cerebral infarction in Chaohu Hospital of Anhui Medical University from January2015 to August 2017 were randomly divided into control（47 cases）and treatment（47 cases）groups.Patients in the control group were iv administered with Urokinase for injection,one million unit added into normal saline 150 m L,and dripped off in 30 min,1 time after admission.Patients in the treatment group were iv administered with Cerebroprotein Hydrolysate for injection on the basis of the control group,10 m L added into normal saline 250 m L,once daily.Patients in two groups were treated for 14 d.After treatment,the clinical efficacy was evaluated,and the NIHSS scores,SF-36 scores,serological indexes and cerebral hemodynamic indexes in two groups before and after treatment were compared.Results After treatment,the clinical efficacy in the control group was 80.85%,which was significantly lower than 95.74%in the treatment group,and there were differences between two groups（P〈0.05）.After treatment,the NIHSS scores in two groups were significantly decreased,but SF-36 scores were significantly increased,and the difference was statistically significant in the same group（P〈0.05）,and these scores in the treatment group were significantly better than those in the control group（P〈0.05）.After treatment,the MMP-9,CD40L,oxygenized low density lipoprotein and Cys C in two groups was significantly decreased（P〈0.05）,and these serological indexes in the treatment group were significantly lower than those in the control group（P〈0.05）.After treatment,the Q（mean） and V（mean ）levels in two groups were significantly increased,but DR,ZCV and R levels were significantly decreased,there were differences in the same group（P〈0.05）,and the cerebral hemodynamic indexes in the treatment group were significantly better than those in the control group（P〈0.05）.Conclusion Cerebroprotein hydrolysate combined with urokinase in treatment of acute cerebral infarction can effectively reduce the inflammatory response,promote the recovery of neurological function and improve cerebral hemodynamics.