前列地尔对糖尿病急性脑梗死患者脑血灌注量及血液黏度影响

Effect of alprostadil on cerebral blood perfusion and blood viscosity in patients with diabetic acute cerebral infarction

目的糖尿病急性脑梗死发生率呈上升趋势,探寻有效治疗方法对改善患者预后具有重要作用。本研究分析前列地尔对糖尿病急性脑梗死患者脑血灌注量及血液黏度的影响,以期为临床治疗提供指导。方法回顾性分析2015-01-01-2016-01-01中国人民解放军第三七一中心医院神经内科治疗的100例糖尿病急性脑梗死患者临床资料,根据其治疗方法将患者分为对照组和观察组,各50例,其中对照组为常规治疗,观察组为常规治疗加用前列地尔注射治疗。比较两组疗效,采用美国国立卫生研究院脑卒中量表(national institutes of health stroke scale,NIHSS)评价神经功能缺损情况,采用Barthel指数(barthel index,BI)计分法评价日常生活能力,比较两组局部脑血流量(regional cerebral blood flow,rCBF)、局部脑血容量(regional cerebral blood volume,rCBV)、平均通过时间(mean transit time,MTT)等脑血灌注量指标,比较两组全血黏度和血浆黏度等血液黏度变化。结果治疗后,观察组治疗总有效率为94.0%,高于对照组的80.0%,χ~2=4.332,P=0.037。观察组NIHSS评分为(7.04±3.12)分,低于对照组的(12.25±5.47)分,t=5.850,P<0.001;BI计分为(66.97±18.12)分,高于对照组的(52.33±16.04)分,t=4.278,P<0.001;观察组rCBV为(4.17±1.24)mL/(100g·min),高于对照组的(3.42±1.16)mL/(100g·min),t=3.123,P=0.002;rCBF为(49.77±21.42)mL/100g,高于对照组的(39.89±19.55)mL/100g,t=2.409,P=0.018;MTT为(6.81±0.82)s,短于对照组的(7.55±0.72)s,t=4.795,P<0.001。观察组全血黏度为(11.23±2.85)mPa·s,低于对照组的(15.33±3.02)mPa·s,t=6.982,P<0.001;血浆黏度为(1.89±0.38)mPa·s,低于对照组的(2.16±0.44)mPa·s,t=3.284,P=0.001。结论前列地尔可提高糖尿病急性脑梗死患者脑血灌注量,降低患者血液黏度,提高患者血液流动性,促进微循环,临床效果显著。

OBJECTIVE The incidence of diabetic acute cerebral infarction is on the rise.Exploring effective treatment methods has an important effect on improving the prognosis of patients.This study analyzes the effect of alprostadil on cerebral blood perfusion and blood viscosity in patients with diabetic acute cerebral infarction in order to provide support for clinical treatment.METHODS Clinical data of 100 patients with diabetic acute cerebral infarction treated in neurology department of the 371th Central Hospital of Chinese People’s Liberation Army were retrospectively analyzed from January 1,2015 to January 1,2016.According to the treatment method,the patients were divided into the control group(n=50) and the observation group(n=50).The control group was given routine treatment,the observation group was treated with conventional treatment and alprostadil.The efficacy,National Institutes of health stroke scale(NIHSS),Barthel index(BI),changes of cerebral blood perfusion indexes such as local cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),mean transit time(MTT) and blood viscosity indexes including whole blood viscosity,lasma viscosity were compared between the two groups.RESULTS After treatment,the total effective rate of the observation group was 94.0%,higher than that of the control group(80.0%),χ^2=4.332,P=0.037.The NIHSS score of the observation group(7.04±3.12) was significantly lower than that of the control group(12.25±5.47),t=5.850,P<0.001.The BI score(66.97±18.12) was significantly higher than that of the control group(52.33±16.04),t=4.278,P<0.001.The rCBV(4.17±1.24) ml/(100 g·min),rCBF(49.77±21.42) ml/100 g in the observation group were higher than those[(3.42±1.16) ml/(100 g·min) and(39.89±19.55) ml/100 g]in the control group(t=3.123,P=0.002;t=2.409,P=0.018).MTT(6.81±0.82) s was shorter than that in the control group(7.55±0.72) s,t=4.795,P<0.001.The whole blood viscosity(11.23±2.85) mPa·s and plasma viscosity(1.89±0.38) mPa·s were lower in the observation group than those in the control group[(15.33±3.02) mPa·s and(2.16±0.44) mPa·s](t=6.982,P<0.001;t=3.284,P=0.001).CONCLUSION Alprostadil can improve the amount of cerebral blood perfusion of patients with diabetic acute cerebral infarction,reduce the blood viscosity,improve the blood flow and promote microcirculation,with significant clinical effect.