丁苯酞氯化钠注射液在急性脑梗死静脉溶栓治疗中的应用研究

Butylphthalide and sodium chloride injection in intravenous thrombolytic therapy of acute cerebral infarction

目的探讨丁苯酞氯化钠注射液在急性脑梗死静脉溶栓中使用能否提高疗效及降低合并出血并发症发生率。方法选择2017年1月至2020年2月期间,入住南昌医学院第一附属人民医院(江西省人民医院)神经内科的发病4.5 h以内的急性脑梗死静脉溶栓患者,静脉溶栓同时给予丁苯酞氯化钠注射液治疗者123例为丁苯酞组;对照组患者49例,静脉溶栓时未给予丁苯酞治疗。采用t检验比较组间年龄、美国国立卫生研究院卒中量表(NIHSS)评分的差异,采用χ^(2)检验及校正χ^(2)检验比较组间性别、既往病史、合并出血发生率和90 d预后良好率的差异。结果2组间基线资料:性别、年龄、糖尿病、高血压、血脂异常、心脏病(不包括心房颤动)、心房颤动、吸烟、嗜酒史、既往患病史及入院时NIHSS评分差异均无统计学意义(P均>0.05)。丁苯酞组患者溶栓后合并出血发生率为21.1%(26/123),低于对照组溶栓后合并出血发生率(32.7%,16/49),但差异无统计学意义(χ^(2)=2.517,P=0.113)。随访90 d后,丁苯酞组预后良好率为63.4%(78/123),高于对照组(44.3%,22/49),差异具有统计学意义(χ^(2)=4.937,P=0.026)。结论丁苯酞氯化钠注射液在急性脑梗死静脉溶栓中使用,可提高静脉溶栓疗效,但未发现其能降低出血并发症发生率。

Objective To investigate whether butylphthalide and sodium chloride injection can improve therapeutic efficacy and reduce hemorrhage complications in intravenous thrombolysis of acute cerebral infarction.Methods A retrospective analysis was performed on patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated People's Hospital of Nanchang Medical College(Jiangxi Provincial People's Hospital)within 4.5 hours of symptom onset from January 2017 to February 2020.123 patients were treated with intravenous thrombolysis with butylphthalide and sodium chloride injection.Another 49 patients were included in the control group,without butylphthalide and sodium chloride injection during intravenous thrombolysis.T Test was used to compare the differences in age and NIHSS scores between groups.The differences in gender,previous medical history,incidence of combined bleeding,and good prognosis at 90 days were compared between the groups usingχ^(2)test with correction.Results Baseline data between the two groups were not statistically significant(P>0.05):gender,age,diabetes,hypertension,dyslipidemia,heart disease(excluding atrial fibrillation),atrial fibrillation,smoking,alcohol consumption history,previous physical health and NIHSS score at admission.The incidence of bleeding after thrombolysis was 21.1%(26/123)in the butylphthalide group,which was lower than that in the control group(32.7%,16/49),but there was no significant difference(χ^(2)=2.517,P=0.113).After 90 days of follow-up,the good prognosis rate in the butylphthalide and sodium chloride injection was 63.4%(78/123),which was higher than that in the control group(44.3%,22/49).The difference was statistically significant(χ^(2)=4.937,P=0.026).Conclusion The application of butylphthalide and sodium chloride injection in intravenous thrombolysis of acute cerebral infarction can improve the efficacy of intravenous thrombolysis.However,it was not found to reduce the incidence of bleeding complications.