银杏酮酯分散片与纤溶酶注射液联合高压氧治疗急性缺血性脑卒中患者前瞻性研究

A Prospective Study of Ginkgo Biloba Ester Dispersible Tablets and Fibrinogenase Injection Combined with Hyperbaric Oxygen Therapy in the Treatment of Acute Ischemic Stroke

目的探讨银杏酮酯分散片与纤溶酶注射液联合高压氧治疗急性缺血性脑卒中(AIS)患者的临床疗效。方法选取本院神经内科2016年1月~2017年1月的住院治疗的AIS患者85例,采用随机数字法将患者分为银杏酮酯组、纤溶酶组和联合用药组,3组患者分别给予银杏酮酯分散片、注射用纤溶酶和银杏酮酯分散片+注射用纤溶酶,同时配合常规药物和高压氧连续治疗2周,对患者入院后和治疗后进行用美国国立卫生研究院卒中量表(NIHSS)进行评分,分别检测活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和纤维蛋白原(FIB),治疗结束后对疗效进行判定。结果组内比较,3组患者治疗结束后APTT水平较治疗前显著增高,NIHSS评分、PT和FIB水平较治疗前显著降低,差异均有统计学意义(t=2.62、4.81、4.25、3.75、4.62、4.13、2.53、6.24、6.34、6.42、4.29、2.41,P<0.05);组间比较,3组患者治疗前NIHSS评分、APTT、PT和FIB水平变化不显著,差异无统计学意义(F=0.51、0.72、0.38、0.61,P>0.05),银杏酮酯组经治疗后NIHSS评分、APTT、PT和FIB水平较纤溶酶组变化不显著,差异无统计学意义(t=0.85、0.81、0.62、0.60,P>0.05),联合治疗组经治疗后APTT水平较纤溶酶组增高,NIHSS评分、PT和FIB水平较纤溶酶组降低,差异均有统计学意义(t=3.72、3.79、2.05、5.47,P<0.05)。纤溶酶组、银杏酮酯组和联合组的临床疗效总有效率分别为65.52%、78.57%和89.29%,银杏酮酯组临床疗效总有效率高于纤溶酶组,但差异无统计学意义(c2=1.20,P>0.05);联合治疗组临床疗效总有效率高于纤溶酶组,差异有统计学意义(c2=4.57,P<0.05)。结论银杏酮酯分散片与纤溶酶联合高压氧治疗AIS中较单独使用的临床疗效好,对其药理作用进一步研究,具有很好的临床推广价值。

Objective To investigate the clinical efficacy of ginkgo biloba ester dispersible tablets and fibrinogenase injection combined with hyperbaric oxygen therapy in the treatment of acute ischemic stroke（AIS）. Methods 85 AIS patients hospitalized in Neurology Department of our hospital from January 2016 to January 2017 were divided into ginkgolide group, fibrinogenase group and combined group by random number method,which were given the ginkgo biloba ester dispersible tablets, fibrinogenase injection, ginkgo biloba ester dispersible tablets ＋ fibrinogenase injection respectively. All three groups simultaneously received the conventional medical treatment and hyperbaric oxygen therapy, tid for 2 weeks. The NIHSS score, APTT, PT and FIB levels were adopted for effect evaluation on before and after treatment. Results After treatment, the APTT levels were increased, the NIHSS score, PT and FIB levels were decreased in all three groups, with statistical difference（t=2.62, 4.81, 4.25, 3.75, 4.62,4.13, 2.53, 6.24, 6.34, 6.42, 4.29, 2.41, P0.05）; the NIHSS score, APTT, PT and FIB levels among three groups after treatment showed no significant difference（F=0.51, 0.72, 0.38, 0.61）; the NIHSS score, APTT, PT and FIB levels had no significant difference between the ginkgolide group and fibrinogenase group after treatment（t=0.85, 0.81, 0.62, 0.60）; While the combined group had a higher NIHSS score, and lower APTT, PT and FIB levels than those in the fibrinogenase group after treatment（t=3.72, 3.79, 2.05, 5.47, P0.05）; the clinical efficacy of the ginkgolide group, fibrinogenase group and combined group were 65.52%, 78.57% and 89.29% respectively, no statistical difference was found between the ginkgolide group and fibrinogenase group（χ2=1.20, P0.05）, while statistical difference was found in the combined group and fibrinogenase group（χ2=4.57, P0.05）.Conclusion The combination of ginkgo biloba ester dispersible tablets and fibrinogenase injection joint with hyperbaric oxygen therapy for AIS patients has a better effect than the single one combined with hyperbaric oxygen therapy, which has a high clinical value.