摘要
目的 探讨疏血通、丁苯酞注射液辅助阿替普酶(rt-PA)溶栓治疗对急性脑梗死(AC1)患者神经功能、认知功能、血液流变学、炎性因子、氧化应激的影响.方法 选取2019年5月至2021年6月我院收治的ACI患者138例,按照rt-PA溶栓后辅助治疗方案不同,分为疏血通联合丁苯酞组(n=69)和丁苯酞组(n=69).两组患者均接受阿替普酶溶栓治疗,丁苯酞组在rt-PA溶栓的基础上给予丁苯酞注射液辅助治疗,疏血通联合丁苯酞组在rt-PA 溶栓的基础上给予疏血通+丁苯酞注射液辅助治疗.比较两组临床疗效、治疗前、治疗2周后神经功能(NIHSS评分)、认知功能(MMSE评分)、日常生活能力(BI评分)、炎症因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、IL-10、超敏C反应蛋白(hs-CRP)]、氧化应激相关指标[脂质过氧化物(LPO)、8-轻化脱氧鸟苷(8-oHdG)、髓过氧化物酶(MPO)、氧化低密度脂蛋白(ox-LDL)]及不良反应.结果 疏血通联合丁苯酞组总有效率(97.10％)高于丁苯酞组(86.96％)(P＜0.05);治疗2周后,疏血通联合丁苯酞组NIHSS评分低于丁苯酞组,MMSE、BI评分高于丁苯酞组(P＜0.05);治疗2周后,疏血通联合丁苯酞组全血高切、中切、低切黏度、血浆黏度、FIB水平均低于丁苯酞组(P＜0.05);治疗2周后,疏血通联合丁苯酞组血清TNF-a、IL-8、hs-CRP水平低于丁苯酞组,血清IL-10水平高于丁苯酞组(P＜0.05);治疗2周后,疏血通联合丁苯酞组血清8-OHdG、LPO、ox-LDL、MPO水平低于丁苯酞组(P＜0.05);疏血通联合丁苯酞组不良反应总发生率(11.59％)与丁苯酞组(8.70％)对比,差异无统计学意义(P＞0.05).结论 疏血通、丁苯酞注射液辅助rt-PA溶栓治疗ACI患者的效果显著,可改善患者的脑神经损伤程度和血液的粘稠状态,有效减轻机体的炎性反应,缓解氧化应激状态,改善患者的认知功能,提高其日常生活能力,改善患者的预后.
Abstract
Objective To investigate the effects of Shuxuetong and butylphthalide injection combined with alteplase(rt PA)thrombolytic therapy on nervous function,cognitive function,hemorheology,inflammatory factors and oxidative stress in patients with acute cerebral infarction(ACI).Methods 138 ACI patients admitted to our hospital from May 2019 to June 2021 were selected and divided into Shuxuetong combined with butylphthalide group(n=69)and butylphthalide group(n=69)according to different adjuvant treatment schemes after rt-PA thrombolysis.The patients in both groups received alteplase thrombolytic therapy.The butylphthalide group received butylphthalide injection as an auxiliary treatment on the basis of rt-PA thrombolysis,and the Shuxuetong combined butylphthalide group received Shuxuetong+butylphthalide injection as an auxiliary treatment on the basis of rt-PA thrombolysis.Compare the clinical efficacy,neurological function(NIHSS score),cognitive function(MMSE score),daily living ability(BI score),and inflammatory factor index(tumor necrosis factor)of the two groups before and after treatment for 2 weeks-α(TNF-α)、Interleukin-8(IL-8),IL-10,high-sensitivity C-reactive pro-tein(hs CRP)],oxidative stress related indicators[lipid peroxide(LPO),8-hydroxydeoxyguanosine(8-oHdG),myeloperoxi-dase(MPO),oxidized low-density lipoprotein(ox LDL)]and adverse reactions.Results The total effective rate of Shuxue-tong combined with butylphthalide group(97.10％)was higher than that of butylphthalide group(86.96％)(P＜0.05);Af-ter 2 weeks of treatment,NIHSS score of Shuxuetong combined with butylphthalide group was lower than that of bu-tylphthalide group,while MMSE and BI scores were higher than that of butylphthalide group(P＜0.05);After 2 weeks of treatment,the whole blood high shear,middle shear,low shear viscosity,plasma viscosity and FIB levels in the Shuxuetong combined with butylphthalide group were lower than those in the butylphthalide group(P＜0.05);After 2 weeks of treat-ment,serum TNF in Shuxuetong combined with butylphthalide group-α、The levels of IL-8 and hs CRP were lower than those in the butylphthalide group,and the levels of IL-10 were higher than those in the butylphthalide group(P＜0.05);Af-ter 2 weeks of treatment,the serum 8-OHdG,LPO,ox LDL,MPO levels in the Shuxuetong combined with butylphthalide group were lower than those in the butylphthalide group(P＜0.05);The total incidence of adverse reactions in Shuxuetong combined with butylphthalide group(11.59％)was not significantly different from that in butylphthalide group(8.70％)(P＞0.05).Conclusion Shuxuetong injection and butylphthalide injection combined with rt PA thrombolytic therapy have a significant effect on ACI patients,which can improve the degree of brain nerve injury and the viscous state of blood,effec-tively reduce the inflammatory reaction of the body,alleviate the oxidative stress state,improve the cognitive function of pa-tients,improve their daily living ability,and improve the prognosis of patients.
维普
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