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目的探讨丹红注射液联合阿替普酶治疗不同分型急性脑梗死的临床疗效。方法选取2013年4月—2015年3月榆林市第二医院和西安交通大学第二附属医院的急性脑梗死患者72例,随机分为对照组和治疗组,每组各36例。对照组给予注射用阿替普酶,0.9 mg/kg,10%静脉推注,90%静脉滴注,1 h内滴注完毕,最大剂量不超过90 mg。治疗组在对照组基础上静脉滴注丹红注射液,20 m L加入到生理盐水250 m L,1次/d。两组患者治疗2周。观察两组的临床疗效,比较两组溶栓前后多普勒超声(TCD)参数、TCD血流分型、神经功能缺损症状量表(NIHSS)评分、Rankin表(m RS)评分的变化。结果治疗后,对照组和治疗组完全闭塞型总有效率分别为66.67%、83.33%,部分闭塞型总有效率分别为81.82%、90.00%,非闭塞型总有效率分别为94.74%、95.00%,两组比较差异无统计学意义。溶栓后,两组完全闭塞、部分闭塞患者收缩期血流速度(Vs)、平均血流速(Vm)、舒张期血流速(Vd)均上升,搏动指数(PI)下降,同组溶栓前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组完全闭塞、部分闭塞比例下降,非闭塞型比例上升,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗1、2周后,两组完全闭塞、部分闭塞、非闭塞患者NIHSS评分均降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的降低程度明显优于同期对照组,两组比较差异具有统计学意义(P<0.05)。治疗后3个月,治疗组部分闭塞和非闭塞患者m RS评分显著下降,同类型治疗前后比较差异有统计学意义(P<0.05);且治疗组非闭塞患者m RS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)。结论丹红注射液联合阿替普酶治疗不同分型急性脑梗死具有较好临床疗效,可改善患者脑功能,促进闭塞血管再通,改善血流动力学,有益于短期预后,安全性好,具有一定的临床推广应用价值。
Objective To investigate the clinical efficacy of Danhong injection combined with alteplase in the treatment of acute cerebral infarction of different types. Methods Seventy-two patients with acute cerebral infarction from the Second Hospital of Yulin City and the Second Affiliated Hospital of Xi’an Jiaotong University from April 2013 to March 2015 were randomly divided into control group and treatment group, 36 cases in each group. Control group was injected with alteplase, 0.9 mg / kg, 10% intravenous injection, 90% intravenous drip infusion within 1 h, the maximum dose does not exceed 90 mg. The treatment group on the basis of the control group intravenous infusion of Danhong, 20 m L added to normal saline 250 m L, 1 / d. Two groups of patients for 2 weeks. The clinical efficacy of the two groups was observed. The changes of TCD, TCD, NIHSS and m RS scores before and after thrombolysis were compared between the two groups. Results After treatment, the total effective rates of complete occlusion in control group and treatment group were 66.67% and 83.33% respectively. The total effective rates of partial occlusion were 81.82% and 90.00% respectively. The total effective rates of non-occlusive and non-occlusive groups were 94.74% and 95.00% , No significant difference between the two groups. After thrombolysis, systolic blood flow velocity (Vs), mean blood flow velocity (Vm), diastolic blood flow velocity (Vd) increased, pulsatility index (PI) decreased in the two groups of patients with complete occlusion and partial occlusion, The difference between the two groups was statistically significant (P <0.05). The improvement of these indexes in the treatment group was obviously better than that in the control group (P <0.05). After treatment, the two groups were completely occluded, the proportion of partial occlusion decreased, and the proportion of non-occlusive increased. There was significant difference between the two groups before and after treatment (P <0.05); and the improvement of the observation group in the treatment group was obviously better than that of the control group The difference between the two groups was statistically significant (P <0.05). After 1 and 2 weeks of treatment, the NIHSS scores of the two groups of patients with complete occlusion, partial occlusion and non-occlusion decreased, with statistical significance (P <0.05) before and after treatment in the two groups; and the degree of reduction of these indexes in the treatment group was significantly superior In the same period of the control group, the difference between the two groups was statistically significant (P <0.05). At 3 months after treatment, the mRS scores of the patients in the partial occlusion and non-occlusion groups decreased significantly compared with those in the control group (P <0.05). The mRS scores of the non-occluded patients in the treatment group were significantly lower than those in the control group , The difference between the two groups was statistically significant (P <0.05). Conclusion Danhong injection combined with alteplase in the treatment of acute cerebral infarction of different subtypes has good clinical curative effect, which can improve brain function, promote occlusion of recanalization, improve hemodynamics, benefit short-term prognosis, good safety, Has a certain clinical application value.