脑苷肌肽联合阿替普酶治疗急性脑梗死的临床研究

Clinical study on cattle encephalon glycoside and ignotin combined with alteplase in treatment of acute cerebral infarction

目的探讨脑苷肌肽注射液联合注射用阿替普酶治疗急性脑梗死的临床疗效。方法选取2015年8月—2017年10月海安市人民医院收治的90例急性脑梗死患者为研究对象。根据入院编号将所有患者分为对照组和治疗组,每组各45例。对照组给予注射用阿替普酶,0.9 mg/(kg·d),总剂量的10%于短时间内静脉推注,剩余90%在1 h内静脉滴注。治疗组在对照组治疗的基础上静脉滴注脑苷肌肽注射液,20 mL加入0.9%氯化钠注射液250 mL中,1次/d。两组均连续治疗14 d。观察两组临床疗效,比较两组患者的美国国立卫生院脑卒中量表(NIHSS)评分、Barthel指数、血液流变学指标和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为82.2%、95.6%,两组比较差异具有统计学意义(P<0.05)。治疗7、14d后,两组NIHSS评分显著降低,Barthel指数显著升高,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗7、14d后,治疗组NIHSS评分、Barthel指数显著优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组全血高切黏度、全血低切黏度、血浆黏度和红细胞压积水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗后,治疗组血液流变学指标显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组S100β蛋白、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)和白细胞介素1β(IL-1β)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05)。治疗后,治疗组血清指标水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗期间,治疗组不良反应发生率为6.7%,显著低于对照组的15.6%,两组比较差异具有统计学意义(P<0.05)。结论脑苷肌肽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,可显著改善患者的神经功能评分和生活质量,降低炎性指标和血液黏度,具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Cattle Encephalon Glycoside and Ignotin Injection combined with Alteplase for injection in treatment of acute cerebral infarction. Methods Patients（90 cases） with acute cerebral infarction in Haian People’s Hospital from August 2015 to October 2017 were divided into control group and treatment group, according to the admission number, and each group had 45 cases. Patients in the control group were given Alteplase for injection, 0.9 mg/（kg·d）,10% of the total dose was pushed intravenous injection in short time, and the remaining dose was continuously intravenous drip within 1 h. Patients in the treatment group were iv administered with Cattle Encephalon Glycoside and Ignotin Injection on the basis of the control group, 20 m L added into 0.9% NaCl injection 250 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and NIHSS scores, Barthel indexes, hemorheological indexes, and serological indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 82.2% and 95.6%, respectively, and there was difference between two groups（P 〈 0.05）. After treatment for 7 and 14 d, NIHSS scores in two groups were significantly decreased, but Barthel indexes were significantly increased, and there were differences in the same group（P 〈 0.05）. After treatment for 7 and 14 d, NIHSS scores and Barthel indexes were better than those in the control group, and there were differences between two groups（P 〈 0.05）. After treatment, high blood viscosity, low blood viscosity, plasma viscosity, and hematocrit levels in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment, hemorheological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, S100β, MMP-9, TNF-α, and IL-1β levels in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. After treatment, serological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. During the treatment, the adverse reaction rate in the treatment group was 6.7%, which was significantly lower than 15.6% in the control group, with significant difference between two groups（P 〈 0.05）. Conclusion Cattle Encephalon Glycoside and Ignotin Injection combined with Alteplase for injection has clinical curative effect in treatment of acute cerebral infarction, can significantly improve patients’ neurological function score and quality of life, reduce inflammatory indexes and blood viscosity, which has a certain clinical application value.