丁苯酞序贯治疗急性脑梗死并大脑中动脉血流增快48例的疗效观察

Therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and increased middle cerebral artery blood flow in 48

目的探讨丁苯酞序贯治疗急性脑梗死并大脑中动脉血流轻中度增快患者的疗效。方法选取2018年1月至2021年10月武汉科技大学附属孝感医院收治的急性脑梗死并大脑中动脉血流轻中度增快患者92例进行回顾性分析,采用随机数字表法分为研究组和对照组,对照组给予静脉滴注丁苯酞氯化钠注射液治疗,研究组静脉滴注丁苯酞氯化钠注射液结束后继续口服丁苯酞软胶囊。比较两组患者基线临床资料、血流动力学、神经功能及临床转归。在治疗后90 d随访时采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、日常生活自理能力自评量表(activity of daily living scale,ADL)及改良Rankin量表(mRS)评估临床转归,应用经颅多普勒超声(TCD)评估血流动力学变化。结果共有92例患者按照要求完成所有观察指标,其中研究组48例,对照组44例。两组人口统计学、血管危险因素、实验室检查、NIHSS评分、ADL评分及病变大脑中动脉血流动力学差异均无统计学意义(均P>0.05)。治疗后90 d,研究组患者NIHSS评分[(4.00±1.95)分比(4.91±2.08)分;t=-2.16,P=0.033]、ADL评分[(82.71±9.56)分比(76.25±11.47)分;t=2.94,P=0.004]及转归良好率[70.83%(34/48)比50.00%(22/44);χ^(2)=4.18,P=0.041]较对照组显著改善;研究组患者病变大脑中动脉收缩期峰值血流速度(systolic velocity,Vs)[(152.33±9.58)cm/s比(157.41±11.77)cm/s;t=2.27,P=0.025]及平均血流速度(mean velocity,Vm)[(90.00±8.30)cm/s比(94.45±9.07)cm/s;t=-2.46,P=0.016]较对照组差异均有统计学意义,搏动指数(pulsitility index,PI)[(0.97±1.06)比(1.01±1.21);t=1.69,P=0.093]差异无统计学意义。与转归不良组比较,转归良好组患者出院后NIHSS评分及ADL评分均降低(均P<0.001),且转归良好组患者采用序贯疗法比例更高[60.70%(34/56)比38.90%(14/36);χ^(2)=4.18,P=0.041]。结论丁苯酞序贯疗法治疗急性脑梗死并大脑中动脉血流轻中度增快患者,能改善神经功能缺损,促进神经功能恢复,改善病变血管的血流动力学,并对患者日常生活活动能力有显著改善作用。

Objective To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed.These patients were divided into a study group and a control group using a random number table method.The control group was given an intravenous infusion of butylphthalein sodium chloride injection,while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection.The baseline data,hemodynamics,neurological function,and clinical outcomes were compared between the two groups.At 90 days after treatment,the National Institutes of Health Stroke Scale(NIHSS),the Activity of Daily Living Scale(ADL),and the modified Rankin Scale(mRS)were used to evaluate clinical outcomes.Transcranial Doppler ultrasound(TCD)examination was performed to evaluate hemodynamic changes.Results A total of 92 patients completed all the observation indices as required,including 48 patients in the study group and 44 patients in the control group.There were no significant differences in demographics,vascular risk factors,laboratory results,NIHSS score,ADL score,or arterial hemodynamics of the diseased brain between the two groups(all P>0.05).At 90 days after treatment,the NIHSS score in the study group was significantly lower than that in the control group[(4.00±1.95)points vs.(4.91±2.08)points;t=-2.16,P=0.033].The ADL score in the study group was significantly higher than that in the control group[(82.71±9.56)points vs.(76.25±11.47)points;t=2.94,P=0.004].The good rate of outcomes in the study group was significantly higher than that in the control group[70.83%(34/48)vs.50.00%(22/44);χ^(2)=4.18,P=0.041].There were significant differences in the peak systolic velocity[(152.33±9.58)cm/s vs.(157.41±11.77)cm/s;t=2.27,P=0.025]and the mean velocity[(90.00±8.30)cm/s vs.[(94.45±9.07)cm/s;t=-2.46,P=0.016]of the middle cerebral artery between the study and control groups.The difference in pulsitility index between the two groups was not statistically significant[(0.97±1.06)vs.(1.01±1.21);t=1.69,P=0.093].Compared with the poor outcome group,patients in the good outcome group had lower NIHSS and ADL scores after discharge(both P<0.001),and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher[(60.70%(34/56)vs.38.90%(14/36);χ^(2)=4.18,P=0.041].Conclusion Sequential therapy with butylphthalein can reduce neurological deficits,promote neurological function recovery,improve the hemodynamics of diseased blood vessels,and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.