阿替普酶联合丁苯酞治疗急性脑梗死的临床研究

Clinical Study of Alteplase Combined with Butylphthalide in the Treatment of Acute Cerebral Infarction

目的:探讨阿替普酶联合丁苯酞治疗急性脑梗死(ACI)的临床疗效。方法:选取2015年3月~2018年12月在本院接受治疗的106例ACI患者作为研究对象,按照随机数字表法将其分为研究组和对照组,各53例。对照组在常规治疗基础上予以注射用阿替普酶治疗,研究组在对照组基础上联合丁苯酞氯化钠注射液治疗。比较两组颈动脉内中膜厚度(IMT)和颈动脉斑块情况,观察两组治疗前和治疗后血清炎症因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、C反应蛋白(CRP)]水平,采用改良的爱丁堡-斯堪的纳维亚卒中量表(MESSS)、简化Fugl-Meyer测评法(FMA)、Barthel指数(BI)分别评估两组治疗前和治疗后神经功能、运动功能、日常生活活动能力,记录两组治疗期间不良反应发生情况。结果:研究组IMT、斑块面积、斑块数低于对照组,高回声斑块占比高于对照组(P<0.05)。治疗后,两组IL-6、IL-8、IL-10、CRP水平低于治疗前,且研究组低于对照组(P<0.05)。治疗后,两组MESSS评分低于治疗前、FMA评分和BI评分高于治疗前,且研究组MESSS评分低于对照组、FMA评分和BI评分高于对照组(P<0.05)。治疗期间,研究组不良反应总发生率低于对照组(P<0.05)。结论:阿替普酶联合丁苯酞治疗ACI患者,可有效减少梗死病灶,降低血清炎症因子水平和机体炎症反应,促进神经功能、运动功能以及日常生活活动能力恢复,且安全性较高,值得临床推广应用。

Objective:To explore the clinical efficacy of ateplase combined with butylphthalide in the treatment of acute cerebral infarction(ACI).Methods:A total of 106 patients with ACI who received treatment in our hospital from March 2015 to December 2018 were selected as the research subjects,and they were divided into research group and control group according to random number table method,with 53 cases in each group.The control group was treated with alteplase for injection on the basis of routine treatment,and the research group was treated with butylphthalide and sodium chloride injection on the basis of the control group.Carotid intima-media thickness(IMT)and carotid plaque were compared between the two groups.The levels of serum inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and C reactive protein(CRP)]of the two groups were observed before and after treatment.The modified Edinburgh-Scandinavia stroke scale(MESSS),Fugl-Meyer assessment(FMA)and barthel index(BI)were used to evaluate the neurological function,motor function and ability of activities of daily living of the two groups before and after treatment.The adverse reactions of the two groups during treatment were recorded.Results:IMT,plaque area and plaque number in the research group were lower than those in the control group,and the proportion of hyperechoic plaque was higher than that in the control group(P<0.05).After treatment,the levels of IL-6,IL-8,IL-10 and CRP in the research group were lower than those in the control group(P<0.05).After treatment,the MESSS score of the two groups was lower than that before treatment,the FMA score and BI score were higher than those before treatment,and the MESSS score of the research group was lower than that of the control group,and the FMA score and BI score were higher than those of the control group(P<0.05).During treatment,the total incidence of adverse reactions in the research group was lower than that in the control group(P<0.05).Conclusion:Alteplase combined with butylphthalide in the treatment of ACI patients can effectively reduce infarct lesions,reduce the level of serum inflammatory factors and body inflammatory response,and promote the recovery of neurological function,motor function and ability of activities of daily living.It is safe and worthy of clinical application.