摘要
目的分析丁苯酞氯化钠注射液联合重组组织型纤溶酶原激活剂(rt-PA)超时间窗溶栓治疗急性脑梗死(ACI)的效果及其对单核细胞趋化蛋白-1(MCP-1)、基质金属蛋白酶9(MMP-9)表达和出血性转化的影响.方法选择2016年8月至2018年8月宜昌市第二人民医院收治的142例超时间窗ACI患者作为研究对象.根据随机数字表法分为观察组和对照组,每组各71例.对照组予以rt-PA静脉溶栓(阿替普酶0.9 mg/kg),溶栓后24 h行CT检查,确认无脑内出血后给予阿司匹林片口服,对阿司匹林不能耐受者给予硫酸氢氯吡格雷片口服,共治疗14 d;观察组在对照组基础上加用丁苯酞氯化钠注射液静脉滴注(静滴),每次25 mg、每日2次,每次治疗时间>50 min,2次用药间隔≥6 h,连续治疗14 d.观察并比较两组的临床疗效、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、血清MCP-1和MMP-9水平、Barthel指数评分以及住院时间、出血性转化率、治疗后5个月病死率和不良反应.结果观察组治疗总有效率明显高于对照组〔85.92%(61/71)比71.83%(51/71),P<0.05〕.两组mRS评分及MCP-1和MMP-9水平均随溶栓后时间延长逐渐降低,且以观察组溶栓后14 d时降低最为明显〔mRS评分(分):1.99±0.21比2.75±0.34,MCP-1(ng/L):157.45±18.55比206.34±24.76,MMP-9(μg/L):110.42±12.57比134.16±14.29,均P<0.05〕.两组Barthel指数评分随溶栓后时间延长逐渐升高,且以观察组溶栓后3个月时升高最为明显(分:74.19±7.54比65.87±6.73,P<0.05).观察组住院时间较对照组明显缩短(d:14.02±1.53比16.79±1.75,P<0.05),且出血性转化率明显低于对照组〔2.82%(2/71)比12.68%(9/71),P<0.05〕;两组治疗后5个月病死率比较差异无统计学意义;两组患者治疗期间均未见明显不良反应.结论丁苯酞氯化钠注射液联合rt-PA超时间窗溶栓治疗ACI效果较好,可明显降低MCP-1、MMP-9水平及出血性转化率,缩短住院时间,改善患者预
Objective To analyze the curative effects of butylphthalide sodium chloride injection combined with recombinant tissue plasminogen activator(rt-PA)for broadened time window thrombolysis in treatment of patients with acute cerebral infarction(ACI)and its influences on expressions of monocyte chemotactic protein-1(MCP-1)and matrix metalloproteinase-9(MMP-9)and hemorrhagic transformation.Methods The clinical data of 142 ACI patients with broadened time window admitted to the Second People's Hospital of Yichang from August 2016 to August 2018 were retrospectively analyzed.According to the random number table method,they were divided into an observation group and a control group,with 71 cases in each group.The control group was treated with rt-PA intravenous thrombolysis(alteplase 0.9 mg/kg),CT examination was performed 24 hours after thrombolysis,Aspirin tablets were given orally after confirming that there was no intracerebral hemorrhage,and those who were intolerant to Aspirin were changed to take clopidogrel bisulfate tablets orally,with the total therapeutic time being 14 days.The observation group was treated with intravenous infusion of butylphthalide sodium chloride based on the treatment of control group(25 mg each time,twice a day,each treatment time>50 minutes,the interval between the two medications≥6 hours),and the treatment was continuous for 14 days.The clinical curative effect,the National Institutes of Health Stroke Scale(NIHSS)score,the modified Rankin Scale(mRS)score,levels of serum MCP-1 and MMP-9,Barthel index score,length of hospital stay,rate of hemorrhagic transformation,mortality and adverse reactions after treatment for 5 months were observed and compared between the two groups.Results The total effective rate of treatment in observation group was significantly higher than that in control group[85.92%(61/71)vs.71.83%(51/71),P<0.05].The mRS scores and the levels of MCP-1 and MMP-9 of the two groups gradually decreased with the time of thrombolysis,and the decreases were the most obvious in t
作者
杨蓉
李寅珍
严首春
Yang Rong;Li Yinzhen;Yan Shouchun(Department of Fundamental Medicine,Hubei College of Chinese Medicine,Jingzhou 434020,Hubei,China;Department of Neurology,the Second People's Hospital of Yichang(the Second People's Hospital of Three Gorges University),Yichang 443000,Hubei,China;Shaanxi University of Chinese Medicine,Xixian New Area 712046,Shaanxi,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第3期316-319,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
湖北省卫生健康委员会科研项目(WJ2019M065)。
关键词
丁苯酞氯化钠注射液
重组组织型纤溶酶原激活剂
时间窗
急性脑梗死
单核细胞趋化蛋白-1
基质金属蛋白酶9
出血性转化
Butylphthalide sodium chloride injection
Recombinant tissue plasminogen activator
Time window
Acute cerebral infarction
Monocyte chemoattractant protein-1
Matrix metalloproteinase-9
Hemorrhagic transformation
