基于CTA评估脑梗死患者服用血府逐瘀汤治疗后的临床预后分析

Evaluation of clinical prognosis of cerebral infarction patients treated with Xuefu Zhuyu Decoction based on CTA

目的 分析基于CT血管造影(CTA)评估脑梗死患者服用血府逐瘀汤治疗后的临床预后。方法 回顾性分析62例脑梗死患者的病历资料,患者入院后均接受CTA检查及血府逐瘀汤治疗,通过CTA-最大密度投影(MIP)评估侧支循环评分(CS)。根据评估结果将患者分为侧支良好组(CS≥2分,32例)和侧支不良组(CS<2分, 30例)。比较两组一般资料,治疗前后认知功能、记忆力、行为能力及短期预后。结果 治疗后,两组蒙特利尔认知评估量表(MoCA)评分和Rivermead行为记忆试验(RBMT)评分均高于本组治疗前,且侧支良好组MoCA、RBMT评分分别为(26.13±1.66)、(22.77±1.08)分,均明显高于侧支不良组的(22.68±1.23)、(20.57±1.12)分,差异有统计学意义(P<0.05)。治疗后,两组连线测验(TMT)-B均短于本组治疗前,神经精神科症状问卷(NPI)-1、NPI-2评分均明显低于本组治疗前,且侧支良好组TMT-B(91.53±10.66)s短于侧支不良组的(112.35±12.48)s, NPI-1评分(4.03±1.29)分、NPI-2评分(0.92±0.13)分均明显低于侧支不良组的(6.88±1.41)、(1.25±0.17)分,差异有统计学意义(P<0.05)。治疗后,两组美国国立卫生研究院卒中量表(NIHSS)评分低于本组治疗前,且侧支良好组NIHSS评分(11.19±1.68)分低于侧支不良组的(15.94±2.08)分,差异有统计学意义(P<0.05);治疗2个月后,侧支良好组改良Rankin量表(mRS)评分(1.69±1.41)分低于侧支不良组的(2.87±1.25)分,差异有统计学意义(P<0.05)。结论 接受血府逐瘀汤治疗后的脑梗死患者,侧支循环良好者可获取更好的认知功能、行为能力等改善效果,同时预后也较为良好。

Objective To evaluate the clinical prognosis of cerebral infarction patients treated with Xuefu Zhuyu Decoction based on CT angiography(CTA).Methods The medical records of 62 patients with cerebral infarction were retrospectively analyzed.All patients received CTA examination and Xuefu Zhuyu decoction after admission.The collateral score(CS)was evaluated by CTA-maximum intensity projection(MIP).According to the evaluation results,the patients were divided into good collateral circulation group(32 cases with CS≥2 points)and poor collateral circulation group(30 cases with CS<2 points).The general data,cognitive function,memory and behavioral ability before and after treatment,and short-term prognosis were compared between two groups.Results After treatment,the scores of Montreal Cognitive Assessment Scale(MoCA)and Rivermead Behavioral Memory Test(RBMT)in both groups were higher than those before treatment in this group;the scores of MoCA and RBMT in the good collateral circulation group were(26.13±1.66)and(22.77±1.08)points,which were significantly higher than those of(22.68±1.23)and(20.57±1.12)points in the poor collateral circulation group;the differences were statistically significant(P<0.05).After treatment,the trail making test(TMT)-B in both groups was shorter than that before treatment in this group,and the scores of neuropsychiatric inventory(NPI)-1 and NPI-2 were significantly lower than those before treatment in this group;TMT-B of(91.53±10.66)s in good collateral circulation group was shorter than that of(112.35±12.48)s in poor collateral circulation group;NPI-1 score of(4.03±1.29)points and NPI-2 of(0.92±0.13)points in good collateral circulation group were significantly lower than those of(6.88±1.41)and(1.25±0.17)points in poor collateral circulation group;the differences were statistically significant(P<0.05).After treatment,the National Institutes of Health Stroke Scale(NIHSS)score in both groups was lower than that before treatment in this group;NIHSS score of(11.19±1.68)points in the good collateral circulation group was lower than that of(15.94±2.08)points in the poor collateral circulation group;the differences were statistically significant(P<0.05).After 2 months of treatment,the score of modified Rankin Scale(mRS)in the good collateral circulation group was(1.69±1.41)points,which was lower than that of(2.87±1.25)points in the poor collateral circulation group,and the difference was statistically significant(P<0.05).Conclusion After receiving Xuefu Zhuyu decoction,cerebral infarction patients with good collateral circulation can obtain better cognitive function,behavioral ability,and the prognosis is better.