静脉溶栓联合醒脑静注射液对脑梗死患者颅内动脉血流动力学指标及神经功能的影响

Effects of intravenous thrombolysis combined with Xingnaojing injection on intracranial arterial hemodynamic indexes and neurological function in patients with cerebral infarction

目的观察静脉溶栓联合醒脑静注射液对脑梗死患者血流动力学指标、神经功能的影响。方法收集2020年4月至2021年5月在兴安盟人民医院治疗的脑梗死患者142例,按照随机数字表法分为对照组(71例,静脉溶栓)、醒脑静组(71例,静脉溶栓+醒脑静注射液)。比较两组患者颅内动脉血流动力学指标、神经缺损评分(NIHSS)、日常运动功能评分(FMA)、血清炎性因子、氧化应激指标、脑损伤标志物及不良反应发生情况。结果治疗后,醒脑静组血清白细胞介素1β(IL-1β)、IL-6、肿瘤坏因子α(TNF-α)水平均显著低于对照组[(4.05±0.83)ng/L比(6.85±1.02)ng/L,(43.61±5.14)ng/L比(60.31±7.04)ng/L,(35.93±4.25)ng/L比(20.93±3.11)ng/L,t=17.94、16.14、15.37,均P<0.001];醒脑静组治疗后大脑前动脉、中动脉、后动脉平均血流速度均显著高于对照组[(49.36±5.28)cm/s比(41.15±5.12)cm/s,(61.27±7.02)cm/s比(50.19±6.08)cm/s,(44.92±5.63)cm/s比(37.26±4.93)cm/s,t=9.40、10.05、8.62,均P<0.001];治疗后,醒脑静组NIHSS、FMA评分均显著优于对照组[(10.36±1.52)分比(14.62±2.05)分,(76.19±8.08)分比(65.28±7.14分,t=14.06、8.52,均P<0.001)];治疗后醒脑静组血清丙二醛水平高于对照组[(6.35±1.02)μmol/L比(10.05±1.63)μmol/L],超氧化物歧化酶水平低于对照组[(114.31±13.69)U/L比(92.25±10.16)U/L],两组差异均有统计学意义(t=16.21、10.90,均P<0.001);醒脑静组患者血清神经元特异性烯醇化酶、星形胶质源性蛋白均低于对照组[(24.01±3.24)IU/L比(30.31±4.02)IU/L,(0.73±0.17)ng/L比(1.13±0.22)ng/L,t=10.28、12.12,均P<0.001];两组不良反应发生率差异无统计学意义(P>0.05)。结论采用静脉溶栓联合醒脑静注射液治疗脑梗死可改善患者颅内血流动力学,减轻炎性反应及氧化应激,减轻脑组织损伤,有利于保护患者神经功能,且安全性高。

Objective To investigate the effects of intravenous thrombolysis combined with Xingnaojing injection on hemodynamic indexes and neurological function in patients with cerebral infarction.Methods A total of 142 patients with cerebral infarction who were treated in Xing An Meng Hospital from April 2020 to May 2021 were included in this study.They were randomly divided into a control group(n=71,intravenous thrombolysis)and a Xingnaojing injection group(n=71,intravenous thrombolysis+Xingnaojing injection).Intracranial arterial hemodynamic indexes,National Institutes of Health Stroke Scale score,Fugl-Meyer Assessment Scale score,serum inflammatory factors,oxidative stress indexes,brain injury markers,and the incidence of adverse reactions were compared between the two groups.Results After treatment,serum levels of interleukin-1β,interleukin-6,and tumor necrosis factor-αwere significantly lower in the Xingnaojing injection group than the control group[interleukin-1β:(4.05±0.83)ng/L vs.(6.85±1.02)ng/L,interleukin-6:(43.61±5.14)ng/L vs.(60.31±7.04)ng/L,tumor necrosis factor-α:(35.93±4.25)ng/L vs.(20.93±3.11)ng/L,t=17.94,16.14,15.37,all P<0.001].After treatment,the mean blood flow velocities of the anterior cerebral artery,middle cerebral artery,and posterior cerebral artery in the Xingnaojing injection group were significantly higher than those in the control group[anterior cerebral artery:(49.36±5.28)cm/s vs.(41.15±5.12)cm/s,middle cerebral artery:(61.27±7.02)cm/s vs.(50.19±6.08)cm/s,posterior cerebral artery:(44.92±5.63)cm/s vs.(37.26±4.93)cm/s,t=9.40,10.05,8.62,all P<0.001].After treatment,the National Institutes of Health Stroke Scale score and Fugl-Meyer Assessment Scale score in the Xingnaojing injection group were superior to those in the control group[National Institutes of Health Stroke Scale score:(10.36±1.52)points vs.(14.62±2.05)points,Fugl-Meyer Assessment Scale score:(76.19±8.08)points vs.(65.28±7.14)points,t=14.06,8.52,both P<0.05].After treatment,the serum level of malondialdehyde in the Xingnaojing injection group was significantly higher than that in the control group[(6.35±1.02)μmol/L vs.(10.05±1.63)μmol/L,t=16.21,P<0.001].The serum level of superoxide dismutase in the Xingnaojing injection group was significantly lower than that in the control group[(114.31±13.69)U/L vs.(92.25±10.16)U/L),t=10.90,P<0.001].Serum levels of neuron-specific enolase and S100βin the Xingnaojing injection group were significantly lower than those in the control group[neuron-specific enolase:(24.01±3.24)IU/L vs.(30.31±4.02)IU/L,S100β:(0.73±0.17)ng/L vs.(1.13±0.22)ng/L,t=10.28,12.12,both(P<0.001).There was a significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Intravenous thrombolysis combined with Xingnaojing injection for the treatment of cerebral infarction can improve intracranial hemodynamics,reduce the inflammatory response and oxidative stress,and alleviate brain tissue injury.The combined therapy is beneficial to protect the neurological function of patients with cerebral infarction and is highly safe.