论文部分内容阅读
目的观察血府逐瘀汤联合阿替普酶静脉溶栓对急性脑梗死患者神经功能恢复及血清超敏C反应蛋白(hs-CRP)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平的影响。方法将120例急性脑梗死且具有溶栓适应证患者随机分为观察组与对照组各60例。所有患者入院后均进入脑卒中单元溶栓急诊路径管理,排除禁忌证后,给予阿替普酶50mg静脉溶栓治疗,溶栓开始后对照组依据2010年版中国急性缺血性脑卒中诊治指南分析患者危险因素给予规范药物治疗;观察组在对照组基础上加用我院自制中药合剂—血府逐瘀汤组方,2组均治疗2周。利用美国国立卫生研究院卒中量表(NIHSS)比较2组神经功能缺损程度评分,运用Barthel指数评价患者日常生活能力。在入院溶栓前及溶栓后24h及治疗后第14天清晨检测患者hs-CRP、IL-1β、TNF-α水平。结果溶栓治疗前,2组患者NIHSS、Barthel指数评分差异无统计学意义(P>0.05)。溶栓后24h,观察组NIHSS评分较对照组明显降低,Barthel指数评分较对照组明显升高,差异均有统计学意义(P<0.05)。治疗14d后观察组NIHSS评分较对照组进一步降低,Barthel指数评分较对照组进一步升高,差异均有统计学意义(P<0.05)。溶栓治疗前,2组患者血清hs-CRP、IL-1β、TNF-α水平差异无统计学意义(P>0.05)。溶栓后24h,观察组血清hs-CRP、IL-1β、TNF-α水平较对照组明显下降,差异有统计学意义(P<0.05)。治疗14d后,观察组血清hs-CRP、IL-1β、TNF-α水平较对照组进一步下降,差异均有统计学意义(P<0.05)。结论血府逐瘀汤联合阿替普酶静脉溶栓治疗能明显改善急性脑梗死患者神经功能缺损程度,提高患者日常生活能力,其机制可能与抑制缺血后再灌注损伤造成的血清炎性因子反应失衡有关。
Objective To observe the effects of Xuefu Zhuyu Decoction combined with intravenous infusion of alteplase on the recovery of neurological function, serum hs-CRP, IL-1β (IL-1β), tumor necrosis factor-α (TNF-α) levels. Methods 120 patients with acute cerebral infarction with thrombolytic indications were randomly divided into observation group and control group, 60 cases each. All patients were admitted to the stroke unit thrombolytic emergency path management, excluding contraindications, given intravenous alteplase 50mg intravenous thrombolytic therapy after the start of thrombolytic control according to the 2010 edition of China’s guidelines for the diagnosis and treatment of acute ischemic stroke The risk factors of patients were given standard medical treatment. The observation group was added with Xuefu Zhuyu Decoction group, which was made by our hospital, on the basis of the control group. Both groups were treated for 2 weeks. The National Institutes of Health Stroke Scale (NIHSS) was used to compare the two groups of neurological deficit score, Barthel index evaluation of patients with daily living ability. The levels of hs-CRP, IL-1β and TNF-α in patients before admission and after thrombolysis 24h and 14 days after treatment were measured. Results Before thrombolysis, there was no significant difference in NIHSS and Barthel index between the two groups (P> 0.05). After 24h, the NIHSS score of the observation group was significantly lower than that of the control group, Barthel index score was significantly higher than that of the control group, the differences were statistically significant (P <0.05). After 14 days of treatment, the NIHSS score of the observation group was further decreased than that of the control group, and Barthel index score was higher than that of the control group (P <0.05). Before thrombolytic therapy, serum hs-CRP, IL-1β, TNF-α levels in two groups had no significant difference (P> 0.05). The levels of hs-CRP, IL-1β and TNF-α in the observation group decreased significantly at 24 h after thrombolysis, with statistical significance (P <0.05). After treatment for 14 days, the levels of serum hs-CRP, IL-1β and TNF-α in the observation group decreased further than those in the control group (P <0.05). Conclusion Xuefu Zhuyu Decoction combined with intravenous thrombolytic therapy with alteplase can significantly improve the degree of neurological deficits and improve the daily living ability in patients with acute cerebral infarction. The mechanism may be related to inhibition of serum inflammatory cytokines induced by ischemia-reperfusion injury Unbalanced response.