磷酸川芎嗪注射液联合阿替普酶治疗急性脑梗死的临床研究

Clinical study on Ligustrazine Phosphate Injection combined with alteplase in treatment of acute cerebral infarction

目的探讨磷酸川芎嗪注射液联合注射用阿替普酶治疗急性脑梗死的临床疗效。方法选取2015年1月—2018年1月重庆市开州区人民医院神经内科收治的急性脑梗死患者300例为研究对象,采用随机数字表法将所有患者分为对照组和治疗组,每组各150例。对照组给予注射用阿替普酶,5 mL加入到生理盐水10 mL中,10 s内静脉推注;而后45 mL加入到生理盐水100 mL,60 min内静脉滴注,1次/d,只给予1次。治疗组在对照组治疗的基础上静脉滴注磷酸川芎嗪注射液,100 mg稀释于5%葡萄糖注射液500 mL中,1次/d。两组均连续治疗10 d。观察两组的临床疗效,比较两组的神经功能缺损情况、抗凝纤溶系统功能、血清生化指标和生活质量。结果治疗后,对照组和治疗组的总有效率分别为81.33%、92.67%,两组比较差异有统计学意义(P<0.05)。治疗后,两组意识、面瘫、水平凝视功能、言语、上下肢肌力、步行能力评分和总评分均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些评分明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组凝血酶原时间均显著延长,纤维蛋白原、血浆高切黏度、红细胞聚集指数均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组抗凝纤溶系统功能指标明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清内皮素-1(ET-1)、血管细胞间黏附分子-1(VCAM-1)、细胞间黏附分子-1(ICAM-1)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组血清生化指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。随访3个月,治疗组躯体功能、角色功能、社会功能、认知功能和总体健康评分均显著高于对照组,两组比较差异有统计学意义(P<0.05)。结论磷酸川芎嗪注射液联合阿替普酶治疗急性脑梗死具有较好的临床疗效,可改善患者临床症状,保护患者脑神经功能,改善患者血液高凝状况,提高患者生活质量,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Ligustrazine Phosphate Injection combined with Alteplase for injection in treatment of acute cerebral infarction. Methods Patients(300 cases) with acute cerebral infarction in Department of Neurology of the People’s Hospital of Kaizhou District, CQ from January 2015 to January 2018 were randomly divided into control and treatment groups, and each group had 150 cases. Patients in the control group were given Alteplase for injection, 5 mL added into normal saline 10 mL, injected into the vein for 10 s, then 45 m L added into normal saline 100 mL, intravenous injection for 60 min, once daily. Patients in the treatment group were iv administered with Ligustrazine Phosphate Injection on the basis of the control group 100 mg, added into 5% glucose solution 500 mL, once daily. Patients in two groups were treated for 10 d. After treatment, the clinical efficacies were evaluated, and neurological deficits, anticoagulant fibrinolysis system function, serum biochemical indicators, and quality of life in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.33% and 92.67%, respectively, and there was difference between two groups(P < 0.05). After treatment, the scores of consciousness, facial paralysis, horizontal gaze, speech, upper and lower limbs muscle strength, walking ability, and total scores in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, prothrombin times in two groups were significantly extended, but fibrinogen, plasma high shear viscosity, and erythrocyte aggregation index in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the anticoagulant fibrinolysis system function indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of ET-1, VCAM-1, and ICAM-1 in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the serum biochemical indicators in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Follow up for 3 months, the scores of physical function, role function, social function, cognitive function, and general health in the treatment group were significantly higher than those in the control group, and there was difference between two groups(P < 0.05). Conclusion Ligustrazine Phosphate Injection combined with Alteplase for injection has clinical curative effect in treatment of acute cerebral infarction, can improve the clinical symptoms, protect the neurological function, improve the blood hypercoagulability, and improve the quality of life of the patients, which has a certain clinical application value.