丁苯酞对急性脑梗死患者脑血流灌注及神经功能的影响

Effect of dl-3n-Butylphthalide on cerebral blood perfusion and neurological function in patients with acute cerebral infarction

目的探讨丁苯酞对急性脑梗死患者局部血流灌注及神经功能的影响。方法应用临床前瞻性研究的方法,严格按照纳入和排除标准选取2018年4月至2020年1月于新乡医学院第一附属医院神经内科住院的患者94例。按患者就诊时间将其随机分为试验组与对照组各47例。对照组按急性脑梗死的标准诊疗方案治疗,试验组在标准诊疗方案治疗基础上联合丁苯酞氯化钠注射液治疗,均连续治疗2周。观察2组患者治疗前、治疗后6个月脑CT灌注成像参数,即局部血流量(rCBF)、局部血容量(rCBV)、达峰时间(TTP)、平均通过时间(MTT)和美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力(ADL)评分的变化情况。采用独立样本t检验比较2组间脑CT灌注参数及NIHSS评分、ADL评分的差异。结果治疗后,试验组rCBF较对照组增高[(36.16±6.65)ml/(100 g·min)vs(32.87±8.48)ml/(100 g·min)]、rCBV较对照组增加[(2.83±0.92)ml/100 g vs(2.42±0.81)ml/100 g],MTT较对照组降低[(3.71±1.10)s vs(4.34±0.96)s]、TTP较对照组缩短[(14.90±4.30)s vs(16.49±2.12)s],差异均具有统计学意义(t=2.091、2.317、-2.981、-2.269,P=0.039、0.023、0.004、0.026);治疗后试验组NIHSS评分较对照组降低[(5.57±3.07)分vs(7.00±3.68)分]、ADL评分较对照组升高[(61.06±17.51)分vs(49.68±15.51)分],差异均具有统计学意义(t=-2.038、3.336,P=0.044、0.001)。结论丁苯酞治疗能够改善脑梗死患者局部血流灌注水平,促进患者神经功能恢复,在急性脑梗死临床治疗方面具有价值。

Objective To investigate the effect of dl-3n-butylphthalide on the cerebral blood perfusion and neurological function in patients with acute cerebral infarction.Methods A total of 94 patients who were hospitalized in the Department of Neurology of First Affiliated Hospital of Xinxiang Medical College from April 2018 to January 2020 were prospectively included in strict accordance with the inclusion and exclusion criteria.The patients were randomly divided into the intervention group(n=47)and the control group(n=47).The control group was treated according to the standard diagnosis and treatment of acute cerebral infarction,while the intervention group was treated with dl-3n-butylphthalide sodium chloride injection on the basis of standard diagnosis and treatment.Both groups were treated continuously for 2 weeks.The perfusion parameters of brain CT were observed before and 6 months after treatment,including regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),transit time to the peak(TTP),and mean transit time(MTT).The changes of National Institutes of Health stroke scale(NIHSS)scores and activities of daily living(ADL)scores were also recorded at diagnosis and 6 months after treatment.Independent sample t test was used to compare the age,baseline blood pressure,blood lipid,fasting blood glucose,onset time,brain CT perfusion parameters(rCBF,rCBV,TTP,MTT),NIHSS score,and ADL score,between the two groups.Results After treatment,rCBF of the intervention group was higher than that of the control group[(36.16±6.65)ml/(100 g·min)vs(32.87±8.48)ml/(100 g·min),t=2.091,P=0.039],and rCBV was higher than that of the control group[(2.83±0.92)ml/100 g vs(2.42±0.81)ml/100 g,t=2.317,P=0.023],MTT of the intervention group decreased than that of the control group[(3.71±1.10)s vs(4.34±0.96)s,t=-2.981,P=0.004],and tTTP of the intervention group decreased than that in the control group[(14.90±4.30)s vs(16.49±2.12)s,t=-2.269,P=0.026];after treatment,NIHSS score of the intervention group was lower than that of the control group[(5.57±3.07)vs(7.00±3.68),t=-2.038,P=0.044],and the ADL score was higher than that of the control group[(61.06±17.51)vs(49.68±15.51),t=3.336,P=0.001].Conclusion Dl-3n-butylphthalide treatment can improve the regional blood flow perfusion level of patients with cerebral infarction,promote the recovery of neurological function,and is beneficial in the clinical treatment of acute cerebral infarction.