静脉溶栓24 h内使用丁基苯酞治疗急性缺血性脑梗死的临床观察

Clinical observation on butylphthalide used within 24 hours of intravenous thrombolysis in treating acute ischemic cerebral infarction

目的:观察重组组织型纤溶酶原激活剂(rtPA)溶栓24 h内使用丁基苯酞(NBP)治疗急性缺血性脑梗死的临床疗效。方法:纳入急性缺血性脑梗死患者160例,随机分为治疗组与对照组,每组各80例。所有患者均给予rtPA溶栓治疗,在rtPA溶栓后24 h复查头颅CT或MRI,未出血者参照指南根据具体病情加用抗血小板聚集药物等。治疗组患者在上述治疗的同时,于rtPA溶栓24 h内使用NBP注射液静脉滴注,连续静脉滴注8~10 d后改用NBP软胶囊口服,NBP治疗至少维持30 d。于rtPA溶栓前、溶栓24 h后及发病90 d时评价两组患者的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRA)评分,计算mRA评分在0~2分的患者百分比;记录并比较两组患者的住院天数以及溶栓后24 h内出现脑出血、再闭塞的例数。结果:溶栓24 h后及发病90 d时,两组患者的NIHSS评分较溶栓前均明显降低(P<0.05),两组中mRS评分在0~2分的患者比例较溶栓前明显升高(P<0.05);且发病90 d时,治疗组患者的NIHSS评分低于对照组(P<0.05),治疗组mRS评分在0~2分的患者比例高于对照组(P<0.05)。两组患者的住院天数及溶栓后出血情况比较,差异均无统计学意义(P>0.05);治疗组的溶栓后再闭塞发生率明显低于对照组(P<0.05)。结论:rtPA溶栓24 h内使用NBP持续治疗能够明显改善急性缺血性脑梗死患者的神经功能缺损,减少溶栓后血管再闭塞,可在临床中推荐使用。

Objective:To observe the clinical efficacy of 3-n-butylphthalide(NBP),which was used within 24 hours of intravenous thrombolysis by recombinant tissue plasminogen activator(rtPA),in the treatment of acute ischemic cerebral infarction.Methods:One hundred and sixty patients with acute ischemic cerebral infarction were included and randomly divided into the treatment group and control group,80 cases in each group.All the patients were treated with intravenous thrombolysis therapy of rtPA,the head CT or MRI was reviewed after rtPA thrombolysis for 24 hours,and the patients who did’t show the second hemorrhage were added with anti-platelet aggregation drugs according to the patients’condition.Based on above treatment,the patients in the treatment group were treated with NBP by intravenous drip within 24 hours of rtPA thrombolysis,with a course of 8-10 days,and then the patients were orally treated with NBP capsules with a course of at least 30 days.Before thrombolysis,24 hours after thrombolysis,and 90 days after onset,the scores of National Institutes of Health stroke scale(NIHSS)and modified Rankin scale(mRS)were evaluated,and the percentage of patients with mRS score ranged from 0 to 2 was calculated;the hospitalization days and the cases of cerebral hemorrhage and reocclusion within 24 hours after thrombolysis were recorded and compared.Results:Twenty-four hours after thrombolysis and 90 days after onset,the NIHSS score was significantly decreased in both groups compared with before thrombolysis(P<0.05),and the percentage of patients with mRS score ranged from 0 to 2 was obviously increased in both groups compared with before thrombolysis(P<0.05);90 days after onset,the NIHSS score of the treatment group was lower than that of the control group(P<0.05),and the percentage of patients with mRS score ranged from 0 to 2 in the treatment group was higher than that in the control group(P<0.05).There were no statistically significant differences on the hospitalization days and the cerebral hemorrhage after thrombolysis between the two groups(P>0.05).The incidence rate of reocclusion after thrombolysis in the treatment group was obviously lower than that in the control group(P<0.05).Conclusion:Continuous treatment with NBP within 24 hours after rt PA thrombolysis can significantly improve the neurological function impairment and reduce the vascular reocclusion after thrombolysis in patients with acute ischemic cerebral infarction,which is worthy of recommend and application in clinic.