高剂量阿托伐他汀钙联合护心益脑方对大脑中动脉梗死伴左心室舒张功能不全患者软脑膜侧支循环的影响及对心脑系统的保护效应  

Effect of high-dose atorvastatin calcium combined with Huxin Yinao decoction on pial collateral circulation in patients with middle cerebral artery infarction and left ventricular diastolic dysfunction and its protective effect on cardio-cerebral system

作　　者：郭忠伟[1] 岳媛媛[1] 苏学会[1] 于常英[1] GUO Zhongwei;YUE Yuanyuan;SU Xuehui;YU Changying(The First Hospital of Qinhuangdao City, Qinhuangdao 066000, Hebei, China)

机构地区：[1]河北省秦皇岛市第一医院

出　　处：《现代中西医结合杂志》2019年第19期2078-2082,2086,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察高剂量阿托伐他汀钙联合护心益脑方对大脑中动脉梗死伴左心室舒张功能不全(LVDD)患者软脑膜侧支循环的影响及对心脑系统的保护效应。方法将92例伴有LVDD的大脑中动脉梗死患者随机分为观察组和对照组,每组46例。对照组给予常规抗血小板、抗凝、清除氧自由基、改善脑循环与营养神经、降低颅内压、降压降糖等治疗及阿托伐他汀钙80mg口服,观察组在对照组治疗基础上加服护心益脑方,2组疗程均为2周。观察2组中医证候积分、格拉斯哥昏迷评分(GCS)、美国国立卫生院神经功能缺损(NIHSS)评分、软脑膜侧支循环、左心室舒张功能变化情况,统计2组临床疗效,并比较随访3个月的预后情况。结果2组治疗后中医证候积分、NIHSS评分均较治疗前明显降低(P均<0.05),GCS评分明显升高(P均<0.05),病变侧大脑前动脉、大脑后动脉平均血流速度(Vm)均显著高于治疗前和对侧(P均<0.05),病变侧大脑前动脉与对侧大脑前动脉的Vm比值、病变侧大脑后动脉与对侧大脑后动脉的Vm比值均显著升高(P均<0.05),软脑膜侧支循环评分分级和评分及心脏彩超检查指标e′、E/e′、E/A均较治疗前显著改善(P均<0.05),NT-proBNP水平均明显降低(P均<0.05),且观察组上述各指标改善情况均明显优于对照组(P均<0.05)。观察组临床总有效率明显高于对照组(P均<0.05);治疗后随访3个月时,观察组改良Rankin量表评分明显低于对照组(P<0.05)。结论高剂量阿托伐他汀钙联合护心益脑方可显著促进大脑中动脉梗死伴LVDD患者软脑膜侧支循环代偿的形成,减轻神经功能损害,改善左心室舒张功能及预后转归。Objective It is to observe the effects of high-dose atorvastatin calcium combined with Huxin Yinao decoction on pial collateral circulation in patients with middle cerebral artery infarction and left ventricular diastolic dysfunction (LVDD) and its protective effect on cardio-cerebral system. Methods 92 patients with middle cerebral artery infarction with LVDD were divided into observation group and control group according to random number table method, 46 cases in each group. The control group was given conventional anti-platelet, anti-coagulation, scavenging oxygen free radicals, improving cerebral circulation and nutritional nerves, reducing intracranial pressure, antihypertensive hypoglycemic and other treatments and atorvastatin calcium 80 mg orally. The observation group was treated with Huxin Yinao decoction based on the control group. Both groups were treated for 2 weeks. The changes of TCM syndrome scores, Glasgow Coma Scale (GCS), National Institutes of Health Neurological Deficit (NIHSS) score, pial collateral circulation, left ventricular diastolic function were observed, and the clinical efficacy of the two groups was assessed, the prognosis after 3 month was followed up. Results After treatment, the TCM syndrome scores and NIHSS scores of the two groups were significantly lower than those before treatment ( P <0.05), and the GCS scores were significantly increased. The mean blood flow velocity (Vm) of cerebral artery and posterior cerebral artery were significantly higher than than before and after treatment ( P <0.05), the Vm ratio of the anterior cerebral artery and the contralateral anterior cerebral artery, and the Vm ratio of the posterior cerebral artery and the contralateral posterior cerebral artery were significantly increased ( P <0.05), the grade and score of pial collateral circulation scores and cardiac color Doppler ultrasound indicators e’, E/e’, E/A were significantly improved compared with that before treatment ( P <0.05), NT-proBNP levels were significantly reduced, and the imp

关 键 词：阿托伐他汀钙 护心益脑方 大脑中动脉梗死 心脑保护 心功能不全 

分 类 号：R743.33[医药卫生—神经病学与精神病学]