血塞通联合阿替普酶治疗急性脑梗死的疗效及对血清ET-1、TXA2水平影响

Effect of Xuesetong(血塞通) Combined with Alteplase on Acute Cerebral Infarction and Effect on Serum Levels of ET-1 and TXA2

目的 探讨血塞通联合阿替普酶治疗急性脑梗死的疗效及对血清血浆内皮素-1(ET-1)、血栓素A2(TXA2)水平影响。方法 选取医院收治的急性脑梗死患者84例,采用随机对照组法分为对照组(44例)和观察组(40例)。两组入院后给予抗血小板聚集、稳定动脉粥样硬化斑块、脑保护等常规治疗,对照组静脉滴注注射用阿替普酶,根据病情及患者体质量选择剂量为0.6 mg/kg或0.9 mg/kg,最多不超过90 mg,首先将总量的10%静脉推注,剩余的1 h静脉泵注;观察组在对照组基础上给予注射用血塞通,推荐剂量为200 mg/次,溶于0.9%生理盐水250 mL静脉滴注,1次/d;两组持续治疗10 d。对比两组临床疗效、BI指数评分、改良Rankin(MRS)评分和美国国立卫生院卒中量表(NIHSS)评分、中医证候评分、血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平、血清ET-1、TXA2水平及血流动力学指标水平变化。结果 治疗后,观察组总有效率较高(P<0.05);治疗前两组BI指数评分、MRS评分和NIHSS评分差异无统计学意义(P>0.05);治疗后两组BI指数评分显著升高,MRS评分和NIHSS评分显著降低(P<0.05);并且观察组改善较明显(P<0.05);治疗后两组中医证候评分、血清炎性因子水平明显降低(P<0.05);且观察组降低较明显(P<0.05);治疗前两组血清ET-1、TXA2水平差异无统计学意义(P>0.05);治疗后两组血清ET-1、TXA2水平明显降低(P<0.05);且观察组较多较明显(P<0.05);治疗前两组血清红细胞比容(HCT)、血全素黏度(WBV)、血浆黏度(FIB)和凝血因子(PV)水平差异无统计学意义(P>0.05);治疗后两组血清HCT、WBV、FIB和PV水平明显降低(P<0.05);且观察组降低较明显(P<0.05)。结论 采用血塞通联合阿替普酶治疗急性脑梗死具有较好的临床疗效,可降低血清ET-1、TXA2水平。

Objective To investigate the efficacy of Xuesaitong(血塞通) combined with alteplase in the treatment of acute cerebral infarction and its effect on serum levels of ET-1 and TXA2.Methods Eighty-four cases of patients with acute cerebral infarction admitted to the hospital were selected and randomly divided into control group(44 cases) and observation group(40 cases).The two groups were given routine treatment such as anti platelet aggregation,stable atherosclerotic plaque and brain protection.The control group was given intravenous injection of alteplase.According to the condition and the weight of patients,the dosage was 0.6 mg/kg or 0.9 mg/kg,which was no more than 90 mg.First,10% of the total amount was injected by intravenous injection,and the remaining was injected by 1 h intravenous pump.The observation group was given Xuesaitong for injection on the basis of the control group.The recommended dose was 200 mg/time,dissolved in 0.9% normal saline 250 mL intravenously,once a day.Both groups were treated for 10 days.The clinical efficacy,Barthel index(BI index) score,Modified Rankin Scale(MRS) score,National Institute of Health stroke scale(NIHSS) score,TCM syndrome score,serum levels of C-reactive protein(CRP),interleukin 6(IL-6),tumor necrosis factor-α(TNF-α),endothelin-1(ET-1),thromboxane A2(TXA2) and hemodynamic indexes of the two groups were compared.RESULTS:After treatment,the total effective rate in the observation group was higher(P0.05).After treatment,BI index scores in two groups were significantly increased,while MRS and NIHSS scores were significantly decreased(P0.05).After treatment,the serum levels of ET-1 and TXA2 in the two groups were significantly decreased(P0.05).After treatment,the serum levels of HCT,WBV,FIB and PV in two groups were significantly decreased(P<0.05).And those of the observation group were decreased significantly(P<0.05).Conclusion Xuesetong combined with alteplase in the treatment of acute cerebral infarction has a good clinical effect,and can reduce serum levels of ET-1 and TXA2.