丁苯酞注射液治疗进展性脑梗死临床疗效观察

发布时间：2018-03-30 23:27

  本文选题：丁苯酞注射液　切入点：进展性脑梗死　出处：《南京医科大学》2016年博士论文

【摘要】：脑梗死(Cerebral infarction,CI)是神经内科常见的缺血性脑血管病,是严重危害人民群众健康主要疾病之一,尤其进展性脑梗死(Progressive cerebral infarction,PCI)在临床上具有进展快,致死率及致残率远较一般脑梗死为高等特点,且难以预测,治疗上也很棘手,容易引发医患矛盾。因此,探讨进展型脑梗死治疗方法,改善进展性脑梗死的预后是临床重要任务之一。研究目的探讨丁苯酞对进展性脑梗死临床疗效及CD34+细胞水平、hs-CRP浓度、颅内平均血流速度及搏动指数,评估丁苯酞对进展性脑梗死的治疗作用,为临床治疗PCI提供新思路。研究方法根据美国国立卫生研究院卒中量表(NIHSS)进行评分,收集2012年9月至2015年12月在江苏省淮安市第二人民医院神经内科住院的进展性脑梗死患者82例,随机分为两组,治疗组42例,对照组40例。对照组给予抗血小板聚集、他汀类药物应用、控制血压、调节血糖及改善脑循环等治疗,治疗组在对照组基础上给予丁苯酞100ml(25mg)应用,每日2次,应用时限为连续应用14d。通过NIHSS评分对比治疗组和对照组二周后神经功能缺损改善程度;改良的RANKIN(Modified Rankin Scale,MRS)观察治疗后90天病情恢复情况;经颅多普勒(Transcranial doppler,TCD)检测脑血流大脑中动脉(Middle cerebral artery,MCA)和大脑后动脉(Posterior cerebral artery,PCA)平均速度(Mean Velocity,Vm)和搏动指数(Pulse index,PI),观察颅内脑血流及血管阻力情况流式细胞仪检测CD34+细胞,观察丁苯酞对颅内血管新生、侧支循环改善情况;采用胶乳增强的免疫比浊法检测hs-CRP水平,判定丁苯酞对进展性脑梗死对缺血引起炎症的控制情况;。研究结果1.入院后脑梗死进展发生前,治疗组NIHSS评分基线分为6.78±3.22,对照组7.07±3.93,两组比较,P0.05,无统计学差异;进展后,治疗组NIHSS评分为15.53±4.47,对照组15.79±4.21,两组NIHSS比较,P0.05,差异无统计学意义。2.治疗组丁苯酞治疗后二周后NIHSS评分7.02±2.98;对照组治疗后二周10.47±2.53。治疗组和对照组NIHSS比较,P0.05,差异显著,有统计学意义。3.治疗二周后,对照组基本痊愈2,显著改善7例,改善19例,无效8例,恶化4例,死亡0例,有效率为22.5%;治疗组基本痊愈6,显著改善22例,改善10例,无效3例,恶化1例,死亡0例,有效率为66.67%,两组比较P0.05,差异有统计学意义。4.两组MRS比较,进展时,u =0.84,P0.05,两组比较无统计学差异;治疗90天后,u=18.4,P0.05 P0.05,差异有统计学意义。5.进展发生时,治疗组大脑中动脉Vm为44.68±7.43,对照组Vm为45.02±7.33;治疗组PI为0.83±0.11,对照组PI为0.82±0.12,两组比较,差异无统计学意义。治疗二周后,治疗组大脑中动脉Vm为53.56±7.62,对照组Vm为47.38±7.31;治疗组PI为0.68±0.11,对照组0.76±0.13,两组比较,Vm及PI均有差异,有统计学意义,P0.05。6.进展发生时,治疗组大脑后动脉Vm为31.23±2.63,对照组Vm为30.98±2.72;治疗组PI为0.84±0.12,对照组PI为0.83±0.13,两组比较,差异无统计学意义。治疗二周后,治疗组大脑后动脉Vm为38.72±3.07,对照组Vm为33.53±2.98;治疗组PI为0.71±0.11,对照组0.77±0.12,两组比较,Vm及PI均有差异,有统计学意义,P0.05。7.治疗前,治疗组CD34+细胞0.035±0.06%,对照组0.036±0.08%,两组之间比较,P0.05,差异无统计学意义;治疗二周后,治疗组CD34+细胞0.054±0.08%,对照组0.040±0.09%,两组比较,P0.05,有统计学意义。8.治疗前,治疗组患者hs-CRP浓度13.56±3.88m/L,对照组为13.49±3.92mg/L,两组之间比较,P0.05,差异无统计学意义。治疗二周后,治疗组hs-CRP 浓度 8.47.±2.72mg/L,对照组 10.53±2.69mg/L,P0.05,有统计学意义。结论应用丁苯酞注射液治疗进展性脑梗死后,可明显减轻患者的神经功能缺损,改善患者的近期疗效;可改善患者的MRS评分,改善患者的远期疗效;丁苯酞可降低血清PCI患者hs-CRP浓度,有抗炎作用;丁苯酞可增加患者CD34+细胞水平,促进血管新生,有改善侧支循环作用。丁苯酞可改善患者脑血流,增加缺血区供血。
[Abstract]:Cerebral infarction (Cerebral infarction CI) is a common neurological ischemic cerebrovascular disease, serious harm to people's health is one of the major diseases, especially for progressive cerebral infarction (Progressive cerebral, infarction, PCI) in clinical practice has developed quickly, the fatality rate and disability rate of cerebral infarction was higher than the general characteristics, and it is difficult to predict, treatment it is very difficult, easy to cause the doctor-patient conflicts. Therefore, to explore the method of treatment of progressive cerebral infarction, improve the prognosis of progressive cerebral infarction is one of the important tasks of clinical research. Objective to investigate the progress of butylphthalide on cerebral infarction clinical curative effect and the level of CD34+ cells, the concentration of hs-CRP, the average intracranial blood flow velocity and pulsatility index, to evaluate the therapeutic effect of butylphthalide the progress of cerebral infarction, to provide new ideas for clinical treatment of PCI. Methods according to the National Institutes of Health Stroke Scale (NIHSS) score collection From September 2012 to December 2015 in Jiangsu province hospital neurology department of Huai'an Second People's Hospital in 82 cases of cerebral infarction were randomly divided into two groups, 42 cases in the treatment group, 40 cases in the control group. The control group was given anti platelet aggregation, blood pressure control, the use of statins, regulate blood sugar and improve cerebral circulation therapy, the treatment group on the basis of the control group on butylphthalide 100ml (25mg), 2 times a day, the time limit for the application of continuous application of 14D. through the NIHSS score between the treatment group and the control group improved neurological deficit after two weeks; modified RANKIN (Modified Rankin Scale, MRS) recovery 90 days observation after treatment; Transcranial Doppler (Transcranial Doppler TCD) cerebral artery blood brain detection (Middle cerebral artery, MCA) and posterior cerebral artery (Posterior cerebral artery PCA (Mean Velocity), mean velocity and pulsatility index (Pulse Vm) index , PI), observe the cerebral blood flow and vascular resistance in CD34+ cells by flow cytometry, observe the butylphthalide on intracranial angiogenesis and collateral circulation to improve the situation; by immune latex enhanced turbidimetric method than hs-CRP level detection, determination of butylphthalide on cerebral infarction on blood deficiency caused by control of inflammation. The results of the study; in 1. hospitalized cerebral infarction occurred before the baseline NIHSS score of treatment group was divided into 6.78 + 3.22, 7.07 + 3.93 P0.05 control group, compared two groups, no significant difference; the progress, the NIHSS score of treatment group was 15.53 + 4.47, 15.79 + 4.21 control group, two groups of NIHSS, P0.05, the difference was not statistically significant.2. group of butylphthalide after two weeks of treatment NIHSS score was 7.02 + 2.98; control group two weeks after treatment 10.47 + 2.53. treatment group and control group NIHSS, P0.05, significant difference was statistically significant.3. after two weeks of treatment, the control group cured 2, significantly 鏀瑰杽7渚，

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