长春西汀联合阿加曲班治疗椎基底动脉供血不足性眩晕症

Clinical observation on vinpocetine in combined with argatroban in the treatment of vertebrobasilar insufficiency vertigo

目的探讨长春西汀、阿加曲班及长春西汀联合阿加曲班在椎-基底动脉供血不足性眩晕症(VBIV)治疗中的效果。方法选取2018年1月至2019年3月河北北方学院附属第一医院收治的VBIV病人90例,采用随机数字表法分为观察1、2、3组,每组各30例,分别给予长春西汀、阿加曲班及长春西汀联合阿加曲班治疗;使用彩色多普勒超声(TCD)检查治疗前后椎动脉血流参数的改变;使用羟胺法检测检测治疗前后三组超氧化物歧化酶(SOD)水平;使用硫代巴比妥酸法(TBA法)测定丙二醛(MDA)含量变化,并对比临床疗效,并对比临床疗效。结果治疗前观察1、2、3组间左椎动脉、右椎动脉及基底动脉血流速度差异无统计学意义,具有可比性(P>0.05),治疗后上述动脉血流速均较治疗前明显提高(P<0.05);观察1、2组治疗后上述动脉血流速比较差异无统计学意义(P>0.05);观察3组治疗后上述动脉血流速均高于观察1、2组[左椎动脉(38.4±4.6)cm/s比(31.1±4.1)cm/s、(31.5±4.1)cm/s,右椎动脉(38.0±4.9)cm/s比(31.8±4.6)cm/s、(31.3±4.6)cm/s,基底动脉(38.0±4.0)cm/s比(32.4±4.7)cm/s、(32.5±4.1)cm/s](P<0.05);治疗前三组间SOD、MDA水平差异无统计学意义,具有可比性(P>0.05),治疗后SOD水平较治疗前明显提高(P<0.05),MDA水平较治疗前明显下降(P<0.05);观察1、2组治疗后SOD、MDA水平比较差异无统计学意义(P>0.05);观察3组治疗后SOD[(73.5±12.8)U/mL比(56.3±10.1)U/mL、(55.1±9.7)U/mL]及MDA[(3.5±1.1)nmol/mL比(4.9±1.9)nmol/mL、(4.8±1.8)nmol/mL]水平改善优于观察1、2组(P<0.05);观察3组治疗1疗程后总有效率为96.7%,观察1、2组分别为76.7%及73.3%;观察3组治疗总有效率高于观察1、2组(P<0.05);观察1、2组间治疗总有效率比较差异无统计学意义(P>0.05)。结论长春西汀联合阿加曲班可迅速缓解VBIV病人临床症状,改善椎-基底动脉血供,疗效优于单纯用长春西汀及阿加曲班治疗,值得临床推广应用。

Objective To explore the effect of vinpocetine in combined with argatroban in the treatment of vertebrobasilar insufficiency vertig(VBIV).Methods A total of 90 patients with VBIV who were admitted in the First Affiliated Hospital of Hebei North University from January,2018 to March,2019 were included in the study and randomized into observation 1,2,and 3 groups.The patients in the three groups were given vinpocetine,argatroban,and vinpocetine in combined with argatroban,respectively.The color Doppler ultrasonic diagnosis apparatus was used to detect the blood flow parameters of vertebral artery before and after treatment.The levels of superoxide dismutase(SOD)in the three groups before and after treatment were detected by hydroxylamine method.The changes of malondialdehyde(MDA)content were determined by thiobarbituric acid method(TBA method).The clinical efficacy was compared.Results The blood flow rate of the left vertebral artery,right vertebral artery,and basilar artery among the three groups before treatment was comparable(P>0.05),while that of the above arteries after treatment was significantly enhanced(P<0.05).The comparison othe blood flow rate of the above arteries after treatment between observation 1 and 2 groups was not significantly different(P>0.05),while that after treatment in observation 3 group was significantly higher than that in observation 1 and 2 groups[the left vertebral artery(38.4±4.6)cm/s vs.(31.1±4.1)cm/s and(31.5±4.1)cm/s,right vertebral artery(38.0±4.9)cm/s vs.(31.8±4.6)cm/s and(31.3±4.6)cm/s,basilar artery(38.0±4.0)cm/s vs.(32.4±4.7)cm/s and(32.5±4.1)cm/s](P<0.05).The comparison of SOD and MDA levels before treatment among the three groups was comparable(P>0.05),while SOD level after treatment was significantly elevated(P<0.05),but MDA level was significantly reduced when compared with before treatment(P<0.05).The comparison of SOD and MDA levels before treatment between observation 1 and 2 groups was not significantly different(P>0.05),while the improvement of SOD[(73.5±12.8)U/mL vs.(56.3±10.1)U/mL and(55.1±9.7)U/mL]and MDA[(3.5±1.1)nmol/mL vs.(4.9±1.9)nmol/mL and(4.8±1.8)nmol/mL]levels after treatment in observation 3 groups was significantly superior to that in observation 1 and 2 groups(P<0.05).The total effective rate after one-course treatment in observation 3 groups(96.7%)was significantly higher than that in observation 1 and 2 groups(76.7%and 73.3%,respectively)(P<0.05).The comparison of the total effective rate between observation 1 and 2 groups was not significantly different(P>0.05).Conclusion Vinpocetine in combined with argatroban in the treatment of VBIV can rapidly relieve the clinical symptoms,and improve the blood supply of vertebro-basilar artery,with efficacy superior to that pure adoption of vinpocetine and argatroban;therefore,it deserves to be widely recommended in the clinic.