丁苯酞注射液预处理对超早期急性脑梗死患者静脉溶栓预后的影响  

Effect of pretreatment with butylphthalide injection on prognosis of intravenous thrombolysis in ultra-early acute cerebral infarction

作　　者：李茜[1] 李永秋[1] 张冬森[1] 张晓涵 Li Qian Li Yongqiu Zhang Dongsen Zhang Xiaohan(Department of Neurology, Tangshan Worker＇s Hospital, Tangshan 063000, Hebei, Chin)

机构地区：[1]唐山工人医院神经内科,河北唐山063000

出　　处：《中国中西医结合急救杂志》2017年第5期519-522,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省医学科研重点课题计划（20160847）.

摘　　要：目的 观察采用重组组织型纤溶酶原激活物（rt-PA）溶栓前及早给予丁苯酞注射液对超早期急性脑梗死（ACI）患者预后的影响.方法 采用前瞻性研究方法.选择2014年9月至2016年3月唐山工人医院神经内科就诊的ACI患者81例,将患者按随机数字表法分为对照组40例和观察组41例.两组患者均给予降压、降糖、降脂稳定斑块、神经保护、活血化瘀等西医常规治疗.对照组在西医常规治疗基础上按溶栓治疗指南直接给予rt-PA静脉溶栓;观察组在入院行头颅CT决定溶栓后,在等待实验室检查结果或转院过程中给予丁苯酞氯化钠注射液100 mL静脉滴注（静滴）,静脉溶栓后若病情平稳,复查头CT除外颅内出血后继续给予丁苯酞氯化钠注射液100 mL、每日2次静滴,两次间隔时间7 h,连用14 d;病情有变化随时复查头颅CT;如病情无变化,静脉溶栓24 h后常规行头颅CT检查,两组患者除外颅内出血后在原治疗基础上加用抗血小板聚集药物.记录两组患者治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、Bartherl指数（BI）评分,观察两组神经功能恢复状况、溶栓后出血转化率、病死率和不良反应发生情况.结果 两组治疗后NIHSS评分较治疗前降低,BI评分较治疗前升高,且以观察组治疗14 d后的变化较对照组更显著〔NIHSS评分（分）：3.87±3.46比7.37±4.18,BI评分（分）：87.38±9.34比75.67±8.05,均P〈0.05〕;观察组的总有效率明显高于对照组〔73.2%（30/41）比55.0%（22/40）,P〈0.05〕,出血转率明显低于对照组〔2.4%（1/41）比7.5%（3/40）,P〈0.05〕;观察组和对照组病死率比较差异无统计学意义〔2.4%（1/41）比2.5%（1/40）,P〉0.05〕.结论 丁苯酞注射液治疗超早期ACI具有较好的临床疗效.Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator （rt-PA） on the clinical prognosis of patients with ultra-early acute cerebral infarction （ACI）. Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker＆#39;s Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group （40 cases） and an observation group （41 cases） according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous （IV） thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient＆#39;s condition was changed, the re-examination of head CT could be done at any time; if the patient＆#39;s condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their

关 键 词：脑梗死 超早期 丁苯酞注射液 重组组织型纤溶酶原激活物 

分 类 号：R654.2[医药卫生—外科学]