氯吡格雷联合依达拉奉右莰醇对急性脑梗死患者的疗效观察

Effect of clopidogrel combined with edaravone dexamphetamine on patients with acute cerebral infarction

目的探讨氯吡格雷联合依达拉奉右莰醇对急性脑梗死(ACI)患者的临床效果。方法本研究为随机对照试验,选取2020年7月至2022年6月湘乡市人民医院收治的124例ACI患者,采用随机数字表法分为两组,各62例。对照组男36例、女26例,年龄(57.47±4.25)岁;观察组男33例、女29例,年龄(58.23±4.45)岁。两组患者常规支持治疗后,对照组给予氯吡格雷治疗,观察组给予氯吡格雷联合依达拉奉右莰醇治疗,治疗周期为2周。比较两组患者治疗前后血清炎症因子[超敏C反应蛋白(hs-CRP)、正五聚蛋白3(PTX3)、脂蛋白相关磷脂酶A2(Lp-PLA2)]、血流动力学指标[阻力指数(RI)、收缩期峰值血流速度(Vmax)、平均血流速度(Vmean)]、氧化应激指标[超氧化物歧化酶(SOD)、活性氧簇(ROS)、丙二醛(MDA)]、神经功能指标[神经元将异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)]、神经功能缺损程度、步行能力及日常生活能力等变化情况,并评估两组患者临床疗效及不良反应。采用t检验、χ^(2)检验。结果治疗后,观察组治疗总有效率为91.94%(57/62),高于对照组75.81%(47/62),差异有统计学意义(χ^(2)=5.962,P=0.015)。治疗后,观察组血清hs-CRP[(7.47±2.34)mg/L]、PTX3[(1.97±0.88)ng/L]、Lp-PLA2[(6.64±1.04)μg/L]、SOD[(123.38±14.62)U/mg]、ROS[(502.42±49.88)μmol/L]、MDA[(40.12±5.02)μmol/L]、NSE[(9.76±1.22)μg/L]、RI[(0.67±0.08)]、美国国立卫生研究院卒中量表(NIHSS)评分[(7.28±0.43)分]、步行能力评分[(1.77±0.12)分]均低于对照组[(10.12±3.32)mg/L、(2.64±1.25)ng/L、(8.52±1.22)μg/L、(147.65±16.26)U/mg、(557.39±52.34)μmol/L、(46.34±5.24)μmol/L、(13.55±2.34)μg/L、(0.78±0.12)、(9.12±0.54)分、(2.44±0.17)分],Vmean[(62.82±5.47)cm/s]、Vmax水平[(87.94±9.78)cm/s]、BDNF[(6.64±0.87)μg/L]、BI[(69.64±7.14)分]均高于对照组[(58.62±5.34)cm/s、(84.14±8.66)cm/s、(5.03±0.82)μg/L、(62.38±6.72)分],差异均有统计学意义(均P<0.05)。结论氯吡格雷联合依达拉奉右莰醇治疗ACI疗效更好,可有效抑制炎性反应,清除氧自由基,从而改善脑内血流的流动,快速恢复缺血半暗带区血流供应,有助于神经功能恢复,增强自理能力,并且安全性较高。

Objective To investigate the clinical effect of clopidogrel combined with edaravone dexamphetamine in the treatment of acute cerebral infarction(ACI).Methods It was a randomized controlled trial.A total of 124 ACI patients admitted to The People's Hospital of Xiangxiang from July 2020 to June 2022 were selected,and were divided into two groups by the random number table method with 62 cases in each group.In the control group,there were 36 males and 26 females,aged(57.47±4.25)years;in the observation group,there were 33 males and 29 females,aged(58.23±4.45)years.After routine supportive treatment,the control group was given clopidogrel,and the observation group was given clopidogrel combined with edaravone dexamphetamine,for a period of 2 weeks.The serum inflammatory factors[hypersensitive C-reactive protein(hs-CRP),pentraxin 3(PTX3),and lipoprotein-associated phospholipase A2(Lp-PLA2)],hemodynamic indexes[resistance index(RI),peak systolic blood velocity(Vmax),and mean blood velocity(Vmean)],oxidative stress indexes[superoxide dismutase(SOD),reactive oxygen species(ROS),and malondialdehyde(MDA)],neurological function indicators[neuron-specific enolase(NSE)and brain-derived neurotrophic factor(BDNF)],degrees of neurological impairment,walking ability,and ability of daily living were compared between the two groups before and after treatment.The clinical efficacies and adverse reactions of the two groups were evaluated.t test andχ^(2) test were used.Results After treatment,the total effective rate of the observation group was 91.94%(57/62),which was higher than that of the control group[75.81%(47/62)],with a statistically significant difference(χ^(2)=5.962,P=0.015).The levels of serum hs-CRP[(7.47±2.34)mg/L],PTX3[(1.97±0.88)ng/L],Lp-PLA2[(6.64±1.04)μg/L],SOD[(123.38±14.62)U/mg],ROS[(502.42±49.88)μmol/L],MDA[(40.12±5.02)μmol/L],and NSE[(9.76±1.22)μg/L],RI[(0.67±0.08)],score of National Institutes of Health Stroke Scale(NIHSS)[(7.28±0.43)points],and walking ability score[(1.77±0.12)points]in the observation group were lower than those in the control group[(10.12±3.32)mg/L,(2.64±1.25)ng/L,(8.52±1.22)μg/L,(147.65±16.26)U/mg,(557.39±52.34)μmol/L,(46.34±5.24)μmol/L,(13.55±2.34)μg/L,(0.78±0.12),(9.12±0.54)min,and(2.44±0.17)min],with statistically significant differences(all P<0.05).In the observation group,the Vmean[(62.82±5.47)cm/s],Vmax[(87.94±9.78)cm/s],level of BDNF[(6.64±0.87)μg/L],and BI[(69.64±7.14)points]were higher than those in the control group[(58.62±5.34)cm/s,(84.14±8.66)cm/s,(5.03±0.82)μg/L,and(62.38±6.72)points],with statistically significant differences(all P<0.05).Conclusion Clopidogrel combined with edaravone dexamphetamine is more effective in the treatment of ACI,which can effectively inhibit the inflammatory response and scavenge oxygen free radicals,thus improving the flow of blood in the brain,rapidly restoring the blood supply to the ischemic hemispheric zone,and contributing to the recovery of neurological function and enhancing the self-care ability,with higher safety.