芪血通络片联合巴曲酶治疗急性脑梗死的临床研究

Clinical study on Qixue Tongluo Tablets combined with batroxobin in treatment of acute cerebral infarction

目的探讨芪血通络片联合巴曲酶注射液治疗急性脑梗死的临床效果。方法以2018年1月—2020年5月在开封市中心医院进行治疗的124例急性脑梗死患者为研究对象,根据住院号的奇偶性分为治疗组(62例)和对照组(62例)。对照组给予巴曲酶注射液,首次10 BU巴曲酶注射液与0.9%氯化钠注射液100 mL配伍,隔日一次,维持量为5 BU,隔日一次静脉滴注;治疗组除了给予巴曲酶注射液外还给予口服芪血通络片,4片/次,3次/d。均治疗14 d进行疗效对比。同时对比两组患者BI评分、ADL评分、MoCA评分、血清新蝶呤(Npt)、单核细胞趋化蛋白-1(MCP-1)、亲环素A(CyPA)、可溶性血管细胞黏附分子-1(sVCAM-1)、基质金属蛋白酶-9(MMP-9)水平,血液流变学指标及脑血流动力学指标。结果治疗后,治疗组在有效率上优于对照组(96.77%比80.65%,P<0.05)。治疗后,两组NIHSS评分、mRS评分显著降低,但ADL评分、MoCA评分、BI评分显著升高(P<0.05);且治疗后治疗组NIHSS评分、mRS评分低于对照组,而ADL评分、MoCA评分、BI评分高于对照组(P<0.05)。治疗后,两组血清Npt、MCP-1、CyPA、MMP-9、sVCAM-1水平均降低,且以治疗组降低更显著(P<0.05)。治疗后,两组Qmean、Vmean显著增加,但DR、ZCV及R显著降低(P<0.05);治疗后,治疗组Qmean、Vmean高于对照组,但DR、ZCV及R显著低于对照组(P<0.05)。治疗后,两组患者HCT、WBV、FIB及PV均明显降低(P<0.05);且治疗后,治疗组血流流变学指标低于对照组(P<0.05)。结论急性脑梗死在给予巴曲酶注射液治疗的同时还进行口服芪血通络片不仅促进机体细胞因子改善,还促进脑血流动力学和血液流变学指标的改善,有利于脑神经功能恢复,促进患者对认知功能的恢复,提高其生活质量,有着很高应用价值。

Objective To explore the clinical effect of Qixue Tongluo Tablets combined with batroxobin in treatment of acute cerebral infarction.Methods Patients(124 cases)with acute cerebral infarction in Kaifeng Central Hospital from January 2018 to May 2020 were randomly divided into control(62 cases)and treatment(62 cases)groups.Patients in the control group were iv administered with Batroxobin Injection,10 BU added into normal saline 100 mL for the first time,and the maintain dose was 5 BU,once every two days.Patients in the treatment group were po administered with Qixue Tongluo Tablets on the basis of the control group,4 tablets/time,three times daily.Patients in two groups were treated for 14 d.After treatment,the clinical efficacy was evaluated,and the BI scores,ADL scores,MoCA scores,the serum levels of Npt,MCP-1,CyPA,MMP-9 and sVCAM-1,Qmean,Vmean,DR,ZCV and R,and the levels of HCT,WBV,FIB and PV in two groups before and after treatment were compared.Results After treatment,the clinical efficacy in the control group was 80.65%,which was significantly lower than 96.77%in the treatment group,and there were differences between two groups(P<0.05).After treatment,NIHSS score and mRS score in both groups were significantly decreased,but ADL score,MoCA score and BI score were significantly increased(P<0.05).After treatment,NIHSS and mRS scores in the treatment group were lower than those in the control group,while ADL,MoCA and BI scores were higher than those in the control group(P<0.05).After treatment,serum Npt,MCP-1,CyPA,MMP-9,and sVCAM-1 levels in the two groups were all decreased,and the decrease was more significant in the treatment group(P<0.05).After treatment,Qmean and Vmean were significantly increased in both groups,but DR,ZCV and R were significantly decreased(P<0.05).After treatment,Qmean and Vmean of the treatment group were higher than those of the control group,but DR,ZCV and R were significantly lower than those of the control group(P<0.05).After treatment,HCT,WBV,FIB and PV were significantly reduced in both groups(P<0.05).After treatment,the blood flow rheology indexes of the treatment group were lower than those of the control group(P<0.05).Conclusion Qixue Tongluo Tablets combined with batroxobin in treatment of acute cerebral infarction can effectively improve the level of cytokines,promote the improvement of cerebral hemodynamics and hemorheology indicators,benefit to the recovery of brain nerve and cognitive function,and improve the quality of life.