丁苯酞联合依达拉奉治疗急性脑梗死患者神经功能及血管内皮功能的影响

Effects of butylphthalide combined with edaravone on neurological function and vascular endothelial function in patients with acute cerebral infarction

目的探讨丁苯酞联合依达拉奉治疗对急性脑梗死(ACI)患者神经功能及血管内皮功能的影响。方法将ACI患者96例随机分为联合组(n=48)和依达拉奉组(n=48)。依达拉奉组在常规治疗基础上给予60mg·d^(-1)×4w,静脉滴注治疗。联合组在依达拉奉组的基础上口服丁苯酞0.2g·d^(-1)×4w治疗。检测比较两组治疗前、治疗1w、2w以及治疗4w的美国国立卫生研究院卒中量表(NIHSS)、全血高切黏度、全血低切黏度、血浆黏度以及红细胞比容等血流动力学指标、血浆一氧化氮(NO)、人内皮素-1(ET-1)、血管内皮细胞生长因子(VEGF)等血管内皮功能指标水平,并统计比较两组28d病死率和不良反应发生率。结果与依达拉奉组比较,联合组治疗1w、2w以及治疗4w的NIHSS得分、血流动力学指标以及血浆ET-1和VEGF水平均降低而同期血浆NO水平则升高(P<0.05)。与治疗前比较,联合组治疗1w、2w以及治疗4w的NIHSS得分、血流动力学指标以及血浆ET-1和VEGF水平均降低而同期血浆NO水平则升高,依达拉奉组治疗2w以及治疗4w的NIHSS得分、血流动力学指标以及血浆ET-1和VEGF水平亦均降低而同期血浆NO水平则升高(P<0.05)。联合组28d病死率为2.08%(1/48),低于依达拉奉组的16.67%(8/48)(P<0.05)。两组肝、肾功能损害、消化道反应、头痛头晕等不良反应发生率比较差异均无统计学意义(P>0.05)。结论丁苯酞联合依达拉奉治疗对急性脑梗死可有效改善神经功能、血管内皮功能及近期预后,有临床应用价值。

Objective To investigate the ffects of butylphthalide combined with edaravone on neurological function and vascular endothelial function in patients with acute cerebral infarction(ACI).Method 96 patients with ACI were randomly divided into combined group(n=48)and edaravone group(n=48)by envelope method.Edaravone group was given intravenous drip of 60mg·d^-1×4w edaravone on the basis of routine treatment.The combined group was treated with butylphthalide 0.2g·d^-1×4w on the basis of edaravone group.Before treatment,after 1w,2w and 4w treatment National Institutes of Health Stroke Scale(NIHSS),whole blood viscosity,whole blood viscosity,plasma viscosity and hematocrit and other blood rheology indexes,and plasma nitric oxide(NO)and endothelin-1(ET-1),vascular endothelial growth factor(VEGF)and other vascular endothelial function indexes level of the two groups were measured,adverse reaction rate and 28d mortality rate of two groups were calculated and compared.Results Compared with edaravone group,after 1w,2w and 4w treatment NIHSS score,blood rheology index and plasma ET-1 and VEGF levels of the combine group were decreased,while the plasma NO level of the combine group was increased(P<0.05).Compared with before treatment,after 1 w,2w and 4w treatment NIHSS score,blood rheology index and plasma ET-1 and VEGF levels of the combine group were decreased,while the plasma NO level of the combine group was increased;And after 2w and 4w treatment NIHSS score,blood rheology index and plasma ET-1 and VEGF levels of th edaravone group were decreased,while the plasma NO level of the edaravone group was increased(P<0.05).The 28d mortality rate of the combine group was 2.08%(1/48),which was lower than the 16.67%(8/48)that of edaravone group(P<0.05).There were no statistically significant differences in liver and kidney damage,digestive tract reaction,headache and dizziness and other adverse reactions rated in the two groups(P>0.05).Conclusion Butylphthalide combined with edaravone in the treatment of ACI can effectively improve the nerve function,vascular endothelial function and short-term prognosis,and its safety is good,therefore,Clinical application value.