丁苯酞联合阿替普酶静脉溶栓对急性缺血性脑卒中患者大脑中动脉血流动力学及血管内皮功能的影响

Effect of Butylphthalide Combined with Intravenous Thrombolysis of Alteplase on Middle Cerebral Arterial Hemodynamics and Vascular Endothelial Function in Patients with Acute Ischemic Stroke

目的 探讨丁苯酞联合阿替普酶静脉溶栓治疗急性缺血性脑卒中(AIS)的临床疗效,以及对患者大脑中动脉血流动力学及血管内皮功能的影响。方法 选取海南省中医院2020年1月至2022年5月收治的AIS患者140例,按随机数字表法分为观察组和对照组,各70例。对照组患者采用阿替普酶静脉溶栓,观察组患者在此基础上加用丁苯酞氯化钠注射液。两组患者均连续治疗14 d。结果 观察组患者总有效率为92.86%,显著高于对照组的81.43%(P <0.05)。与对照组比较,观察组患者治疗后的美国国立卫生研究院卒中量表(NIHSS)评分、大脑中动脉搏动指数(PI)和阻力指数(RI)、血清内皮素-1(ET-1)水平均显著降低,Barthel指数(BI)评分、大脑中动脉收缩期峰值血流速(Vp)、血清血管内皮生长因子(VEGF)及一氧化氮(NO)水平均显著升高(P <0.05)。观察组和对照组患者治疗期间不良反应发生率相当(7.14%比12.86%,P> 0.05)。结论 丁苯酞联合阿替普酶静脉溶栓治疗AIS的临床疗效良好,可有效改善患者大脑中动脉血流灌注和血管内皮功能,促进神经功能及日常活动能力恢复,且安全性良好。

Objective To investigate the clinical efficacy of butylphthalide combined with intravenous thrombolysis of alteplase in the treatment of acute ischemic stroke(AIS),and its effect on the middle cerebral arterial(MCA) hemodynamics and vascular endothelial function in patients.Methods A total of 140 patients with AIS admitted to the Hainan Hospital of Traditional Chinese Medicine from January 2020 to May 2022 were selected and randomly divided into the observation group and the control group by the random number table method,with 70 cases in each group.The patients in the control group received intravenous thrombolysis of alteplase,on this basis,the patients in the observation group were treated with Butylphthalide Sodium Chloride Injection.Both groups were continuously treated for 14 d.Results The total effective rate in the observation group was 92.86%,which was significantly higher than 81.43% in the control group(P<0.05).After treatment,the National Institutes of Health Stroke Scale(NIHSS) score,MCA pulsatility index(PI),resistance index(RI),and serum endothelin-1(ET-1) level in the observation group were significantly lower than those in the control group,while the Barthel index(BI) score,peak systolic blood flow velocity(Vp) of the MCA,serum vascular endothelial growth factor(VEGF) level,and nitric oxide(NO) level in the observation group were significantly higher than those in the control group(P>0.05).During treatment,the incidence of adverse reactions in the observation group was comparable to that in the control group(7.14% vs.12.86%,P<0.05).Conclusion Butylphthalide combined with intravenous thrombolysis of alteplase has good clinical efficacy and safety in the treatment of AIS,which can effectively improve the MCA hemodynamics and vascular endothelial function of patients,and promote the recovery of neurological function and ability of daily activity.