吕虎,范从华,王晓伟
LV Hu,FAN Conghua,WANG Xiaowei

• 1:西昌市人民医院急诊科
• 2:成都市第一人民医院急诊科

摘要(Abstract)：

目的:探讨丁苯酞联合阿替普酶静脉溶栓治疗对急性脑梗死(ACI)患者神经功能缺损及日常生活能力的影响。方法:选取ACI患者,经倾向性匹配评分后分为治疗组和对照组各51例;治疗组患者在常规处理基础上,予以丁苯酞联合急诊阿替普酶静脉溶栓治疗,对照组患者予以常规治疗及阿替普酶静脉溶栓,连续用药14 d后评价治疗效果;比较两组治疗前、治疗后第1、7、14天用美国国立卫生研究院卒中量表(NIHSS)评价患者的神经功能缺损、用Barthel指数评价患者的日常生活能力;治疗14 d时,比较两组患者血清中枢神经特异性蛋白(S-100β)、神经元特异性烯醇化酶(NSE)等脑神经损伤指标,记录两组患者用药期间药物不良反应。结果:治疗后第1、7、14天时,治疗组NIHSS评分均显著低于对照组、差异有统计学意义(P <0. 05),Barthel指数均高于对照组,差异有统计学意义(P <0. 05);治疗14 d时,治疗组总有效率98. 04%,显著高于对照组的82. 35%,差异有统计学意义(P <0. 05),治疗组血清S-100β、NSE水平均显著低于对照组(P <0. 05);治疗组与对照组不良反应发生率分别为15. 69%、7. 84%,两组比较差异无统计学意义(P> 0. 05)。结论:丁苯酞联合阿替普酶静脉溶栓用于ACI患者治疗,有利于改善患者神经功能缺损、促进日常生活能力恢复、提高临床疗效,且安全性较好。
Objective: To investigate the effects of intravenous thrombolytic therapy with Butylphthalide combined with Alteplase on neurological deficits and activity of daily living in patients with acute cerebral infarction( ACI). Methods: Patients with ACI were selected and assigned to treatment group and control group in equal number( n = 51) according to propensity matching score.In addition to routine treatment,treatment group was given intravenous thrombolytic therapy with Butylphthalide combined with emergency Alteplase,and control group was given routine treatment and Alteplase intravenous thrombolysis. The treatment effects were evaluated after 14 d of continuous medication. National Institutes of Health Stroke Scale( NIHSS) was adopted to evaluate the neurological deficits,and barthel index was used to assess the activity of daily living before treatment and 1,7,and 14 d after treatment. On the 14 thd of treatment,cerebral nerve injury indicators of serum central nerve specific protein( S-100β) and neuron specific enolase( NSE) of both groups were compared,and the adverse reactions during medication were recorded. Results: On 1 st,7 thand 14 thd of treatment,the NIHSS score of treatment group was significantly lower than that of control group,differences were statistically significant( P < 0. 05),and the Barthel index of treatment group was significantly higher than that of control group,differences were statistically significant( P < 0. 05). 14 d after treatment,the total effective rate of treatment group was significantly higher than that of control group( 98. 04% vs 82. 35%),differences were statistically significant( P < 0. 05). The levels of serum S-100β and NSE of treatment group were significantly lower than those of control group( P <0. 05). The incidence rate of adverse reactions for treatment group and control group was 15. 69% and7. 84% respectively, differences were not statistically significant( P > 0. 05). Conclusion:Intravenous thrombolytic therapy with Butylphthalide combined with Alteplase for patients with ACI is beneficial to improve neurological deficits,promote recovery of activity of daily living and enhance the clinical efficacy.

关键词(KeyWords)： 组织型纤溶酶原激活物;急性脑梗死;静脉溶栓;丁苯酞;神经功能;日常生活能力
tissue plasminogen activator;acute cerebral infarction(ACI);intravenous thrombolysis;butylphthalide;neurological function;activity of daily living

Abstract:

Keywords:

基金项目(Foundation): 凉山州技术研究开发与推广应用项目(19YYJS0091)

作者(Author): 吕虎,范从华,王晓伟
LV Hu,FAN Conghua,WANG Xiaowei

DOI: 10.19367/j.cnki.2096-8388.2020.12.023

参考文献(References)：

• [1]李雪梅，赵志鸿．急性脑梗死静脉溶栓/桥接治疗24 h内血小板活化的研究进展[J]．中国动脉硬化杂志，2019,27(5):445-450.
• [2] DANOUN O,SACHAR P,RAJAMANI K. Thrombolysis for acute ischemic stroke after protamine reversal of heparin[J]. Am J Ther,2018,25(5):e552-e554.
• [3]魏亮，张小峰，张军峰．阿替普酶治疗急性脑梗死疗效观察[J]．新乡医学院学报，2019,36(6):533-535.
• [4]侯园园，梁志刚，孙旭文．丁苯酞对缺血性脑卒中的保护机制及治疗研究进展[J]．医学综述，2018,24(19):3841-3846.
• [5]贾建平，陈生弟．神经病学[M]. 7版．北京:人民卫生出版社，2013:175-186.
• [6]贺大权，秦雪颖，赵丹华，等．阿替普酶动、静脉溶栓治疗急性缺血性脑卒中的比较性研究[J]．实用临床医药杂志，2016,20(17):21-24.
• [7]金俏，魏连桂，刘林．银丹心脑通软胶囊对急性脑梗死患者血清炎性因子、MESS评分、Barthel指数的影响[J]．现代中西医结合杂志，2016,25(28):3088-3090.
• [8]王雪．阿加曲班和低分子肝素钙治疗急性脑梗死的效果比较[J]．中国医药，2016,11(4):528-532.
• [9] ZHANG T,XIANG L. Elevated plasma haptoglobin level as a potential marker for poor prognosis in acute cerebral infarction[J]. Eur Neurol,2018,79(3-4):154-160.
• [10]THOMALLA G,SIMONSEN CZ,BOUTITIE F,et al.MRI-guided thrombolysis for stroke with unknown time of onset[J]. N Engl J Med,2018,379(7):611-622.
• [11]李宏建．急性缺血性卒中后早期停用或继续抗凝治疗的比较[J]．国际脑血管病杂志，2018,26(8):582.
• [12]LEE X R,XIANG G L. Effects of edaravone,the free radical scavenger,on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of recombinant tissue plasminogen activator.[J] Clin Neurol Neurosur,2018,167:157-161.
• [13]路蔚，魏志强，李新．急性缺血性卒中阿替普酶静脉溶栓后短期转归的影响因素[J]．国际脑血管病杂志，2018,26(4):262-265.
• [14]钟建斌，沈庆煜，陈炽邦，等．超高龄脑梗死患者超早期应用阿替普酶静脉溶栓治疗的效果及安全性[J]．实用医学杂志，2016,32(7):1058-1060.
• [15]王建，董力，贾晨红．丁苯酞注射液对急性脑梗死患者神经功能及脑血管储备功能的影响[J]．实用临床医药杂志，2015,19(11):117-118.
• [16]陈雅静．丁苯酞对神经系统疾病的保护作用研究进展[J]．国际神经病学神经外科学杂志，2019,46(3):337-341.
• [17]崔冰冰，尹榕，刘天珍，等．丁苯酞的药理作用及临床疗效研究进展[J]．解放军医药杂志，2019,31(6):11-14.
• [18]朱烨，吴雅利，李宝香，等．丁苯酞联合阿替普酶对急性脑梗死患者神经功能、认知功能和Hcy等血清学指标的影响[J]．中国药房，2018,29(8):1095-1098.
• [19]程奎山，戴益斌，谢军朋，等．脑梗塞再灌注患者血清NSE及S-100β蛋白变化及丁苯酞的干预作用[J]．海南医学，2016,27(19):3102-3104.
• [20]王洪志，张静波，于远军．丁苯酞联合阿替普酶治疗对急性缺血性脑卒中患者血清NSE、S100β水平的影响[J]．卒中与神经疾病，2017,24(6):530-533.

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