丁苯酞氯化钠注射液联合介入治疗急性前循环大血管闭塞性卒中患者的疗效观察

The effect of butylphthalide injection combined with interventional therapy on patients with acute anterior circulation large vessel occlusive stroke

目的观察丁苯酞氯化钠注射液联合介入治疗急性前循环大血管闭塞性卒中患者的临床疗效。方法回顾性纳入2015年2月至2017年12月在东部战区总医院神经内科住院的急性前循环大血管闭塞并且接受急诊介入治疗的患者173例。根据是否使用丁苯酞氯化钠注射液将其分为丁苯酞组和对照组,运用倾向评分匹配分析平衡丁苯酞组和对照组患者的基线特征及比较两组患者的90d功能预后。结果最终共纳入患者144例,其中丁苯酞组54例,对照组90例,丁苯酞组90d良好功能结局比例高于对照组[63.0%(34/54)与44.4%(40/90);χ^2=4.633,P=0.031]。经倾向评分成功匹配36对,丁苯酞组和对照组各36例患者。两组90d功能结局差异无统计学意义[66.7%(24/36)与44.4%(16/36);χ^2=3.600,P=0.058]。其中再通良好患者115例,丁苯酞组47例,对照组68例,倾向评分匹配30对,丁苯酞组90d良好功能结局比例比对照组高[73.3%(22/30)与46.7%(14/30);χ^2=4.444,P=0.035]。结论经倾向评分匹配前,丁苯酞氯化钠注射液不能改善急性前循环大血管闭塞性卒中再通患者的90d功能结局;而经倾向评分匹配后,丁苯酞氯化钠注射液能够进一步改善这些患者的90d功能结局。

Objective To investigate the effect of butylphthalide and sodium chloride injection on patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke. Methods A total of 173 patients were identified from February 2015 to December 2017 in the Department of Neurology of Jingling Hospital in this retrospective observational study. Propensity score-matching analysis was performed to balance differences in baseline characteristics between patients who received butylphthalide injection (butylphthalide group) and those who did not (control group). The modified Rankin Scale scores at 90 days were compared between the butylphthalide and control groups. Results A total of 144 patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke were finally analyzed, 54 cases in the butylphthalide group and 90 cases in the control group. The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (63.0%(34/54) vs 44.4%(40/90);χ^2=4.633, P=0.031). Thirty-six pairs were matched successfully by the propensity score matching, 36 patients in the butylphthalide group and 36 in the control group. There was no statistically significant difference in the 90-day functional outcome between the two groups (66.7%(24/36) vs 44.4%(16/36);χ^2=3.600, P=0.058). One hundred and fifteen patients were recanalized, 47 cases in the butylphthalide group and 68 cases in the control group, and after the propensity score matching, 30 pairs were analyzed. The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (73.3%(22/30) vs 46.7%(14/30);χ^2=4.444, P=0.035). Conclusion After propensity score-matching, butylphthalide and sodium chloride injection could improve 90-day functional outcome in patients with acute anterior circulation large vessel occlusive stroke and obtained recanalization by endovascular treatment while could not before propensity score-matching.