法舒地尔对急性脑梗死患者溶栓治疗后再灌注损伤和微循环指标的影响

Effects of fasudil on reperfusion injury and micro-circulation indexes in patients with acute cerebral infarction after thrombolysis

目的探讨法舒地尔对急性脑梗死(ACI)患者溶栓治疗后再灌注损伤和微循环指标的影响。方法选取2019年1月至2019年12月本院收治的92例经静脉溶栓治疗的ACI患者,采用随机数字表法分为观察组和对照组各46例。对照组予静脉溶栓及常规治疗,观察组在此基础上加用法舒地尔,均持续治疗14 d。于治疗前后,检测两组血清超氧化物歧化酶(SOD)、丙二醛(MDA)、神经元特异性烯醇化酶(NSE)及中枢神经特异性蛋白(S100-β)水平,记录两组美国国立卫生研究院卒中量表(NIHSS)及脑卒中专门化生存质量量表(SS-QOL)评分。于治疗结束后,检测两组大脑中动脉(MCA)和基底动脉(BA)的收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm),并记录两组治疗期间用药安全性情况。结果观察组治疗后的SOD、MDA、NSE、S100-β水平及NIHSS、SS-QOL评分分别为(107.38±32.75)U/ml、(6.28±2.11)nmol/ml、(5.15±1.37)μg/L、(6.11±1.96)μg/L、(5.03±1.27)分、(192.45±11.62)分;对照组分别为(94.53±25.71)U/ml、(7.46±2.34)nmol/ml、(6.08±1.96)μg/L、(7.52±2.34)μg/L、(6.32±1.36)分、(148.63±10.43)分,治疗后观察组的氧化应激、神经功能指标及NIHSS、SS-QOL评分均明显优于对照组(均P<0.05)。治疗后,观察组BA和MCA的Vm、Vd、Vs分别为(29.17±2.15)cm/s、(20.15±2.63)cm/s、(55.67±4.11)cm/s、(76.98±8.77)cm/s、(46.64±5.12)cm/s、(103.48±10.52)cm/s,均明显高于对照组的(21.03±2.03)cm/s、(15.37±2.06)cm/s、(46.92±4.83)cm/s、(66.54±7.93)cm/s、(40.02±4.38)cm/s、(92.06±9.58)cm/s(均P<0.05)。结论法舒地尔能减轻ACI患者溶栓治疗后再灌注损伤程度,改善患者微循环指标,促进神经功能恢复,且安全性良好。

Objective To explore the effects of fasudil on reperfusion injury and micro-circulation indexes in patients with acute cerebral infarction(ACI)after thrombolysis.Methods Ninety-two ACI patients who underwent intravenous thrombolysis in our hospital during the period from January to December 2019 were enrolled.They were divided into observation group and control group by the random number table method,46 cases in each group.The control group was given intravenous thrombolysis and routine treatment,and the observation group was given fasudil on the basis of the control group.All patients were continuously treated for 14 d.Before and after treatment,the levels of serum superoxide dismutase(SOD),malondialdehyde(MDA),neuron-specific enolase(NSE),and central nervous system-specific protein(S100-β)in both groups were detected,the scores of National Institutes of Health Stroke Scale(NIHSS)and Stroke-specific Quality of Life(SS-QOL)in both groups were recorded.At end of treatment,peak systolic velocity(Vs),end diastolic velocity(Vd),and mean velocity(Vm)of middle cerebral artery(MCA)and basilar artery (BA) in both groups were detected. The medication safety during treatment in both groupswas recorded. Results After treatment, the levels of SOD, MDA, NSE, S100- β, and the scores ofNIHSS and SS-QOL in the observation group were (107.38±32.75) U/ml, (6.28±2.11) nmol/ml,(5.15±1.37) μg/L, (6.11±1.96) μg/L, (5.03±1.27) points, (192.45±11.62) points, those in the controlgroup were (94.53±25.71) U/ml, (7.46±2.34) nmol/ml, (6.08±1.96) μg/L, (7.52±2.34) μg/L, (6.32±1.36) points, (148.63±10.43) points, respectively. After treatment, oxidative stress, nerve functionindexes, and the scores of NIHSS and SS-QOL in the observation group were significantly better thanthose in the control group (all P<0.05). After treatment, Vm, Vd, and Vs of BA and MCA in theobservation group were (29.17±2.15) cm/s, (20.15±2.63) cm/s, (55.67±4.11) cm/s, (76.98±8.77)cm/s, (46.64±5.12) cm/s, (103.48±10.52) cm/s, which were significantly higher than those in thecontrol group [(21.03±2.03) cm/s, (15.37±2.06) cm/s, (46.92±4.83) cm/s, (66.54±7.93) cm/s,(40.02±4.38) cm/s, (92.06±9.58) cm/s] (all P<0.05). Conclusion Fasudil can alleviate reperfusioninjury in ACI patients after thrombolysis, improve micro-circulation indexes, and promote therecovery of nerve function, with good safety.