丁苯酞氯化钠注射剂对于急性缺血性脑卒中溶栓治疗的影响

Effect of butylphthalide sodium chloride injection on thrombolytic therapy of acute ischemic stroke

目的探讨丁苯酞氯化钠注射剂对适合溶栓治疗的急性缺血性脑卒中患者出血性转化的影响。方法收集上海交通大学医学院附属同仁医院神经内科2015年3月至2019年3月发病时间在4.5 h以内的急性缺血性脑卒中,且符合重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)溶栓治疗的患者93例,患者分为3组,其中A组(35例)给予丁苯酞氯化钠注射剂,随后给予rt-PA溶栓治疗结合常规治疗;B组(30例)给予rt-PA溶栓治疗结合常规治疗;C组(28例)为对照组,未给予溶栓治疗。治疗前、后10 d以及随访90 d时,对患者进行美国国立卫生研究院脑卒中量表(National Institute of Health stroke scale,NIHSS)、改良Rankin量表(modified Rankin scale,mRS)评估,比较变化情况。以治疗后24 h以及10d的头部CT扫描、CT血管造影(CT angiography,CTA)或磁共振血管造影(magnetic resonance angiography,MRA)判断出血性转化及临床转归。结果治疗后10 d,A、B两组N1HSS及mRS评分均低于C组,且A组低于B组(P<0.05);随访90 d时,A、B两组NIHSS及mRS评分均低于C组,且A组mRS低于B组(P<0.05)。A组及B组的血管再通或部分再通率分别为65.71%和36.67%,显著高于C组的7.14%(P<0.05)。此外,A组(8.57%)出血性转化率显著低于B组(26.67%,P<0.05)。结论接受rt-PA溶栓结合丁苯酞氯化钠注射剂治疗的患者血管再通率明显提高,出血性转化显著减少。

Objective To explore the effect of butylphthalide sodium chloride injection on hemorrhagic transformation in patients with acute ischemic stroke suitable for thrombolytic therapy.Methods A total of 93 patients with acute ischemic stroke whose onset time was less than 4.5 hours were enrolled in the the Department of Neurology,Tongren Hospital,Shanghai Jiaotong University School of Medicine,from March 2015 to March 2019 and who were eligible for thrombolytic therapy with recombinant tissue-type plasminogen activator(rt-PA).The patients were randomly divided into 3 groups according to the different treatment drugs.Group A(n=35)was given butylphthalide sodium chloride injection,followed by rt-PA thrombolytic therapy combined with conventional treatment.Group B(n=30)was given only rt-PA thrombolytic therapy combined with conventional treatment.Group C(n=28)was the control group and no thrombolytic therapy was given.The National Institute of Health stroke scale(NIHSS)and modified Rankin Scale(mRS)were assessed and compared before treatment,10 days after treatment and 90 days after follow-up.The hemorrhagic transformation and clinical outcome were determined by head CT scan,CTA or MRA at 24 hours and 10 days after treatment.Results Ten days after treatment,NIHSS and mRS in group A and B were lower than those in group C,and those in group A were lower than those in group B(P<0.05).After 90 days of follow-up,NIHSS and mRS in group A and B were lower than those in group C,and mRS in group A was lower than that in group B(P<0.05).The rates of recanalization or partial recanalization in group A and group B were 65.71%and 36.67%,respectively,which were significantly higher than that of group C(7.14%,P<0.05).In addition,the hemorrhagic transformation rate of group A(8.57%)was significantly lower than that of group B(26.67%,P<0.05).C o n c lu s io n rt-PA thrombolysis combined with butylphthalide sodium chloride injection can significantly improve the rate of vascular recanalization and significantly reduce the hemorrhagic transformation.