丁苯酞联合尤瑞克林治疗慢性脑供血不足的临床效果观察

发布时间：2018-07-06 08:21

本文选题：慢性脑供血不足 + 丁苯酞　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的利用动脉质子自旋标记(Arteiral spin labeling,ASL)灌注成像技术观察丁苯酞联合尤瑞克林治疗慢性脑供血不足(Chronic cerebral circulatory insufficiency,CCCI)的临床效果,期望为CCCI的临床治疗提供依据。方法选取2015年10月-2016年10月就诊于河北省唐山工人医院神经内科并确诊为CCCI的患者,将符合入组标准的研究对象采用信封抽签方式随机分为3组,联合治疗组因选择支架植入术脱落2例,最终收录丁苯酞组25例,尤瑞克林组25例,联合治疗组有23例。参照2014版中国缺血性脑卒中和短暂性脑缺血发作二级预防指南,给予三组研究对象相应支持和防治并发症、活血化瘀等常规治疗,丁苯酞组在给予常规治疗的基础上加用丁苯酞氯化钠注射液100ml静点,每日1次,连续给药14天;尤瑞克林组在常规治疗的基础上给予尤瑞克林0.15 PNAU(pnitroaniline单位),将其混于100ml 0.9%的氯化钠注射液中,静脉滴注30分钟,一日1次,连续使用14天;联合治疗组在常规治疗的基础上同时给予丁苯酞注射液100ml及尤瑞克林注射液0.15 PNAU静点治疗,疗程同样为14天。患者于治疗前后行磁共振ASL检查,观察治疗前后患者的患侧脑血流量(Cerebral blood flow,CBF)、健侧CBF值及相对脑血流量值(Relative cerebral blood flow,r CBF)的变化,r CBF=患侧CBF/健侧CBF,进而评价丁苯酞联合尤瑞克林治疗CCCI的临床疗效。结果1基线资料比较:三组患者的年龄、性别及危险因素(包括吸烟史、高脂血症、高血压、糖尿病及心脏病)进行比较,差异无统计学意义(P0.05),具有可比性。2 ASL脑血流量结果:三组患者治疗后患侧CBF、r CBF值均高于治疗前(P0.05),治疗前后的变化有统计学意义;治疗前后健侧CBF值的变化无显著差异(P0.05)。治疗前后,联合治疗组的患侧CBF、r CBF值的增加均高于另外两组,且比较有统计学意义(P0.05)。3临床效果比较:联合治疗组总有效率87%,高于丁苯酞组(71%)和尤瑞克林组(68%)(P0.05)。4尤瑞克林组出现1件不良事件,联合治疗组1例,丁苯酞组未出现不良事件。不良事件只有2例,无统计学意义。丁苯酞与尤瑞克林临床上联合应用安全可靠,可放心使用。结论1利用ASL技术可以观察丁苯酞联合尤瑞克林改善CCCI低灌注情况;2丁苯酞与尤瑞克林联合应用治疗方案对于改善CCCI患者低灌注、增加局部脑血流量及改善患者临床症状等方面作用显著,优于两种单独应用。3丁苯酞与尤瑞克林联合应用过程中无明显不良反应及毒副作用,可以安全应用。
[Abstract]:Objective to observe the clinical effect of butyphthalide combined with eucrine in the treatment of chronic cerebral circulatory insufficiency by using proton spin-labeled (Arteiral spin labelingus perfusion imaging technique, and to provide evidence for clinical treatment of chronic cerebral circulatory insufficiency. Methods the patients who were diagnosed as CCCI in Department of Neurology, Tangshan Workers Hospital, Hebei Province from October 2015 to October 2016 were randomly divided into 3 groups by drawing lots in envelopes. In the combined treatment group, 2 cases were lost because of selective stent implantation, 25 cases in the butyrophthalide group, 25 cases in the eucrine group and 23 cases in the combined treatment group. Referring to the 2014 edition of China's secondary guidelines for the prevention of ischemic stroke and transient ischemic attack, three groups of subjects were given corresponding support, prevention and treatment of complications, and routine treatment of promoting blood circulation and removing blood stasis. In butyphthalide group, 100ml was added to the routine therapy, once a day for 14 days. On the basis of routine therapy, Urethrin group was given Urethrin 0.15 PNAU (pnitroaniline unit), mixed with 0.9% of 100ml sodium chloride injection, intravenous drip for 30 minutes, once a day, continuously used for 14 days. The combined group was treated with butyphthalide injection (100ml) and eurexacin injection (0.15 PNAU) on the basis of routine treatment. The course of treatment was 14 days. The patients underwent Mr ASL before and after treatment. The changes of cerebral blood flow (CBF), relative cerebral blood flowrate (CBF) and relative cerebral blood flowrate (CBF) were observed before and after treatment. The clinical efficacy of butyphthalide combined with eurekline in the treatment of CCCI was evaluated. Results 1 comparison of baseline data: age, sex and risk factors (including smoking history, hyperlipidemia, hypertension, diabetes and heart disease) were compared among the three groups. There was no significant difference (P0.05), there was no significant difference in CBF before and after treatment (P0.05), and there was no significant difference in CBF before and after treatment (P0.05). Before and after treatment, the CBF of the affected side in the combined treatment group was higher than that in the other two groups. The total effective rate of the combined treatment group was 87, which was higher than that of the butylphthalide group (71%) and the eurexacin group (68%) (P0.05). The adverse events in the combined treatment group (1 case) were higher than those in the butyphthalide group (68%) (P0.05), while in the combined treatment group (1 case), there were no adverse events in the butylphthalide group. There were only 2 cases of adverse events with no statistical significance. The combination of butyphthalide and eurekline is safe and reliable in clinical use. Conclusion (1) by using ASL technique, it can be observed that butyphthalide combined with Urethrin can improve the low perfusion of CCCI patients and that the combination of butyrophthalide and Urethrin can improve the low perfusion of CCCI patients. The effects of increasing the local cerebral blood flow and improving the clinical symptoms of the patients were significant, which were superior to those of the two groups in combination of butyrophthalide and eurexacin. There were no obvious adverse reactions and side effects during the treatment, so they could be safely used.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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