目的 探讨丹参多酚酸联合重组人组织型纤溶酶原激活物(rt-PA)治疗急性大面积脑梗死(AMCI)的疗效及对近期预后的影响.方法 选取2019年3月至2023年3月阿坝藏族羌族自治州人民医院收治的82例AMCI患者,按照随机数字表法分为A组和B组各41例.A组在对症治疗的基础上给予rt-PA治疗,B组在A组基础上联合丹参多酚酸进行治疗,评估两组疗效,观察两组治疗前后的氧化指标[血浆丙二醛(MDA)、超氧化物歧化酶(SOD)],神经损伤指标[心型脂肪酸结合蛋白(H-FABP)、N端前脑钠肽(NT-proBNP)]水平,炎症因子水平[C反应蛋白(CRP)、白介素-6(IL-6)水平],血管内皮因子[血浆内皮素-1(ET-1)、一氧化氮(NO)及血管内皮生长因子(VEGF)]水平,以及活动功能[美国国立卫生院卒中量表(NIHSS)与Barthel指数量表(BI)]评分,并记录治疗期间两组不良反应.结果 治疗后,B组总有效率高于A组,NIHSS评分低于 A 组,BI 评分高于 A 组(P＜0.05);B 组血清 MDA、H-FABP、NT-proBNP、CRP、IL-6 和 ET-1 水平均低于 A 组,SOD、NO、VEGF高于A组(P＜0.05);治疗期间两组无明显不良反应发生.结论 丹参多酚酸联合rt-PA治疗AMCI,能改善机体抗氧化水平,有效减轻神经损伤,降低炎症水平,促进血管生成,近期预后良好.
Clinical effect of salvianolic acids combined with recombinant human tissue plasminogen activator in the treatment of acute massive cerebral infarction and its impact on short-term prognosis
Objective To explore the curative effect of salvianolic acids combined with recombinant tissue plasminogen activator(rt-PA)in the treatment of acute massive cerebral infarction(AMCI)and its influences on short-term prognosis.Methods A total of 82 patients with AMCI admitted to our hospital between March 2019 and March 2023 were enrolled.The patients were divided into group A and group B according to random number table method,41 in each group.The group A was treated with rt-PA on basis of symptomatic treatment.The group B was treated with salvianolic acids on basis of the group A.The curative effect after treatment,nerve function,and activities of daily living before and after treatment were evaluated in the two groups.The oxidative stress indexes such as plasma malondialdehyde(MDA)and superoxide dismutase(SOD),nerve injury factors such as heart-type fatty acid binding protein(H-FABP)and N terminal pro-B-type natriuretic peptide(NT-proBNP),inflammatory factors such as C-reactive protein(CRP),interleukin-6(IL-6)and vascular endothelial factors such as plasma endothelin-1(ET-1),nitric oxide(NO)and vascular endothelial growth factor(VEGF)as well as activity function indexes such as National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)scores before and after treatment in the two groups were observed.The adverse reactions were also recorded.Results After treatment,total response rate was higher,the NIHSS score was lower,and the BI score was higher in the group B than those in the group A(P＜0.05).The levels of serum MDA,H-FABP,NT-proBNP,CRP,IL-6 and ET-1 in the group B were lower than those in the group A,while the levels of SOD,NO and VEGF were higher than those in the group A(P＜0.05).There was no significant difference in adverse reactions between the two groups.Conclusions Salvianolic acids combined with rt-PA can improve the antioxidant level,effectively relieve the nerve injury,reduce the levels of inflammatory factors,and promote the angiogenesis in patients with AMCI.The short-term prognosis of the patients was good.
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