补阳还五汤联合rt-PA静脉溶栓治疗急性脑梗死的效果及对炎症因子、脑动脉血流的影响

Effect of Buyang Huanwu Decoction Combined with rt-PA Intravenous Thrombolysis in the Treatment of Acute Cerebral Infarction and Its Influence on Inflammatory Factors and Cerebral Arterial Blood Flow

目的:探讨补阳还五汤联合rt-PA静脉溶栓治疗急性脑梗死的效果及对炎症因子、脑动脉血流的影响。方法:选择龙岩人民医院2018年1月-2021年1月收治的96例急性脑梗死患者作为研究对象,按收治顺序将患者分为观察组和对照组,每组48例。对照组单纯给予重组组织型纤溶酶原激活剂(rt-PA)0.6~0.9 mg/kg治疗,最大剂量<90 mg,先静脉推注总剂量的10%,再在60 min内将剩下药液静脉滴注完成,观察组在对照组的基础上采用补阳还五汤,1剂/d,连续口服30 d。治疗前后进行中医症候积分、神经功能NIHSS评分和日常生活能力ADL评分,采用头颅超声诊断仪测定脑动脉血流指标[血流速度(Vm)、舒张末期血流速度(EDV)、收缩期峰值流速(PSV)],采用酶联免疫吸附试验法检测基质金属蛋白酶-3(MMP-3)、超敏C反应蛋白(hs-CRP),使用化学发光法检测肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6),溶栓后24 h进行临床近期评估,溶栓后30 d进行临床远期疗效评估。结果:两组治疗后中医症候评分及NIHSS评分较治疗前明显降低(P<0.05),ADL评分较治疗前明显升高(P<0.05);观察组治疗后中医症候、NIHSS评分明显低于对照组(P<0.05),ADL评分明显高于对照组(P<0.05)。两组治疗后脑动脉血流指标Vm、EDV、PSV较治疗前明显升高(P<0.05),观察组治疗后Vm、EDV、PSV明显高于对照组(P<0.05)。两组治疗后炎症因子MMP-3、hs-CRP、TNF-α、IL-6较治疗前明显降低(P<0.05),观察组治疗后MMP-3、hs-CRP、TNF-α、IL-6明显低于对照组(P<0.05)。对照组近期临床有效率为50.00%,观察组为52.08%,两组近期疗效差异无统计学意义(P>0.05);对照组远期临床有效率为60.42%,观察组为85.42%,两组远期疗效差异有统计学意义(P<0.05)。结论:补阳还五汤联合rt-PA静脉溶栓治疗急性脑梗死的效果确切,能够有效促进神经功能缺损恢复及改善日常生活能力,提高远期疗效,其作用机制与抑制炎症因子释放及增加脑血流有关。

Objective:To investigate the effect of Buyang Huanwu Decoction combined with rt-PA intravenous thrombolysis in the treatment of acute cerebral infarction and its influence on inflammatory factors and cerebral arterial blood flow.Method:A total of 96 patients with acute cerebral infarction admitted to Longyan People’s Hospital from January 2018 to January 2021 were enrolled.The patients were divided into observation group and control group according to the order of admission,48 cases in each group.The control group was treated with Recombinant Tissue Plasminogen Activator(rt-PA)0.6-0.9 mg/kg,the maximum dose was<90 mg,10%of the total dose was intravenously injected first,and the remaining liquid was intravenously injected within 60 min;the observation group was supplemented with Buyang Huanwu Decoction on the basis of the control group,one dose per day,oral administration for 30 days.TCM syndrome scores,neurological function NIHSS scores and ADL scores of daily living ability were measured before and after treatment;the cerebral arterial blood flow indexes[blood flow velocity(Vm),end-diastolic blood flow velocity(EDV),peak systolic velocity(PSV)]were detected by cranial ultrasonic diagnostic instrument.The matrix metalloproteinase-3(MMP-3)and hypersensitive C-reactive protein(hs-CRP)were detected by enzyme-linked immunosorbent assay,and the tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected by chemoluminescence assay.The clinical short-term effect were evaluated 24 hours after thrombolysis,and the clinical long-term efficacy was evaluated 30 days after thrombolysis.Result:The TCM symptom score and NIHSS score of the two groups after treatment were significantly lower than those before treatment(P<0.05),and the ADL score was significantly higher than that before treatment(P<0.05).The TCM symptom and NIHSS score in the observation group were significantly lower than the control group(P<0.05),ADL score was significantly higher than the control group(P<0.05).The Vm,EDV and PSV of cerebral arterial blood flow in the two groups after treatment were significantly higher than those before treatment(P<0.05).The Vm,EDV and PSV in the observation group were significantly higher than those in the control group(P<0.05).The inflammatory factors MMP-3,hs-CRP,TNF-αand IL-6 in the two groups after treatment were significantly lower than those before treatment(P<0.05),the MMP-3,hs-CRP,TNF-αand IL-6 in the observation group were significantly lower than the control group(P<0.05).The short-term clinical effective rate of the control group was 50.00%,the observation group was 52.08%,there was no significant difference in the short-term efficacy between the two groups(P>0.05).The long-term clinical effective rate of the control group was 60.42%,the observation group was 85.42%.the difference was statistically significant(P<0.05).Conclusion:Buyang Huanwu Decoction combined with rt-PA intravenous thrombolysis is effective in the treatment of acute cerebral infarction.It can effectively promote the recovery of neurological deficit and improve the ability of daily living,improve long-term efficacy.The mechanism of action is related to inhibiting the release of inflammatory factors and increasing cerebral blood flow.