经颅多普勒超声辅助动脉溶栓后联合活血化瘀汤治疗急性脑梗死临床疗效研究

发布时间：2018-03-15 00:05

  本文选题：急性脑梗死　切入点：经颅多普勒超声　出处：《中华中医药学刊》2017年10期 　论文类型：期刊论文

【摘要】：目的:观察经颅多普勒超声辅助动脉溶栓联合活血化瘀汤治疗急性脑梗死的临床疗效,优化临床治疗效果。方法:选取医院收治的80例急性脑梗死患者作为观察对象,采用SPSS 19.0生成随机数字表,按入院顺序随机分为研究组40例和对照组40例,对照组给予重组人组织型纤溶酶原激活剂(rt-PA)动脉溶栓,并给予经颅多普勒超声(TCD)辅助溶栓,术后给予双重抗血小板聚集、扩容、改善血液循环及神经保护等常规西药治疗,观察组在对照组的基础上,术后再口服活血化瘀汤,连续服用14 d,治疗前、治疗后7 d、治疗后14 d进行神经功能缺损评分(NIHSS评分)及日常生活活动能力量表(Barthel指数)评分,治疗前后进行血液流变学指标[血细胞比容(HCT)、全血高切黏度(HWBV)、全血低切黏度(LWBV)、血浆黏度(PV)、纤维蛋白原(FIB)]、炎症因子[白介素-6(IL-6)、超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子-a(TNF-a)]及血浆和肽素(copeptin)检测,比较两组临床疗效。结果:研究组和对照组治疗后7 d、治疗后14d的NIHSS评分均明显下降(均P0.05),Barthel指数均明显升高(均P0.05),但研究组NIHSS评分下降更明显(均P0.05),Barthel指数升高更明显(均P0.05)。研究组治疗后HCT、HWBV、LWBV、PV、FIB均明显下降(均P0.05),对照组仅HWBV、LWBV、PV明显下降(均P0.05),且研究组HCT、HWBV、LWBV、FIB下降更明显(均P0.05)。两组治疗后IL-6、hs-CRP、TNF-a、copeptin均明显下降,但研究组IL-6、hs-CRP、TNF-a、copeptin下降更明显(P均0.05)。研究组的临床总有效率为92.5%,对照组为77.5%,差异具有统计学意义(χ~2=11.652,P0.05)。结论:经颅多普勒超声辅助动脉溶栓后再联合活血化瘀汤可优化临床治疗效果,有效降低炎性因子水平及和肽素水平,改善血液流变学,恢复对病灶脑组织的供血供氧,促进神经功能缺损恢复及日常生活能力改善,提高了患者生活质量。
[Abstract]:Objective: to observe the clinical effect of transcranial Doppler ultrasound assisted arterial thrombolysis combined with Huoxue Huayu decoction in the treatment of acute cerebral infarction. According to the order of admission, SPSS 19.0 was randomly divided into study group (n = 40) and control group (n = 40). The control group was treated with recombinant human tissue plasminogen activator (rt-PA) as thrombolytic agent, and with transcranial Doppler ultrasound (TCD) as an assistant thrombolytic agent. After operation, the patients in the observation group were treated with dual anti-platelet aggregation, dilatation, improved blood circulation and nerve protection, and the observation group was treated with Huoxue Huayu decoction for 14 days after operation, on the basis of the control group. 7 days after treatment and 14 days after treatment, the neurological impairment score (NIHSS) and the activity of daily living (ADL) scale (Barthel index) were evaluated. Before and after treatment, the indexes of hemorheology [HCT, HWBV, LWBV, PVN, FIBF], inflammatory factor [IL-6, hs-CRPN, tumor necrosis factor-aox-TNF-a] and hs-CRPU were measured before and after treatment, and the levels of hs-CRPU, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, hs-CRPU, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪, IL-6, hs-CRPU, TNF- 伪 were measured. Plasma and peptide copeptin, Results: the NIHSS scores of the study group and the control group were significantly decreased at 7 days after treatment and 14 days after treatment (all P 0.05) and the NIHSS scores of the study group were significantly lower than those of the control group (P 0.05%, P 0.05) and that of the control group was higher than that of the control group (P < 0.05), but the NIHSS score of the study group was significantly lower than that of the control group (P < 0.05). After treatment, HCTBV and LWBVV PVFIB in the study group were significantly decreased (all P 0.05), while in the control group, only HWBV / LWBVV PV was significantly decreased (all P 0.05), and the HCTV-HWBV LWBVFIB in the study group was significantly lower than that in the control group (P0.05). After treatment, IL-6 hs-CRPTNF-acoptin was significantly decreased in the study group (P < 0.05), and the level of HWBVV in the study group was significantly lower than that in the control group (P < 0.05), and the level of HWBV in the study group was significantly lower than that in the control group (P < 0.05). The total effective rate of the study group was 92.5 and that of the control group was 77.5, the difference was statistically significant (蠂 ~ (2 +) ~ (2) ~ (11.652)) P 0.05.Conclusion: Transcranial Doppler ultrasound assisted arterial thrombolysis and combined with Huoxue Huayu decoction can optimize the clinical therapeutic effect. It can effectively reduce the levels of inflammatory factors and peptide, improve hemorheology, restore blood and oxygen supply to the brain tissue, promote the recovery of nerve function defect and improve the ability of daily living, and improve the quality of life of the patients.
【作者单位】： 莱芜市人民医院;
【基金】：莱芜市科学技术局项目[(2013)第111,(2014)第086]
【分类号】：R743.3
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本文编号：1613522