瑞替普酶联合丁苯肽胶囊改善急性进展性大脑中动脉缺血性脑卒中患者的临床预后  

R-PA combined with butylphthalide soft capsules treatment improve the clinical prognosis in patient with acute progressive MCA cerebral ischemic stroke

作　　者：李柏林[1] 邹育明 梁春娜[1] 梁明俊[1] 黄光锐[1] 谢富华[2] LI Bolin;ZOU Yuming;LIANG Chunna;LIANG Mingjun;HUANG Guangrui;XIE Fuhua(Department of Emergency, The Centre Hospital of Kaiping City, Jiangmen 529300, China;Intensive Care Unit, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China)

机构地区：[1]开平市中心医院急诊科,广东江门529300 [2]广州医科大学附属第二医院ICU,广东广州510000

出　　处：《分子影像学杂志》2019年第3期414-417,共4页Journal of Molecular Imaging

基　　金：江门市卫生计生局科学技术研究项目(18A026)

摘　　要：目的研究瑞替普酶(R-PA)联合丁苯肽胶囊在治疗进展性大脑中动脉急性缺血性脑卒中患者临床预后改善情况。方法通过倾向性匹配法选取2015年1月1日~2017年5月31日在我科接受治疗的急性进展性大脑中动脉缺血性脑卒中患者87例,根据治疗方法不同分为两组:观察组44例,采用R-PA联合丁苯肽胶囊进行治疗;对照组43例,采用阿替普酶(rt-PA)联合丁苯肽胶囊进行治疗,其他治疗及康复两组患者保持一致。比较评价两组患者不同阶段的近期临床预后(NIHSS评分)和远期临床预后(GOS和ADL评分)情况。结果观察组和对照组患者在性别构成、平均年龄、发病距开始治疗时间、脑梗死范围、入院时GCS评分等病情信息的差异均无统计学意义(P>0.05),具有较好的一致性;观察组和对照组患者在溶栓治疗后2h、24h、7d3个时间点的神经功能缺失情况差异无统计学意义(P>0.05),但是在第1月时观察组组患者的NIHSS评分均值更低,差异有统计学意义(P<0.05);观察组较对照组在第3、6、9月时GOS、ADL评分均更高,在第3月时差异无统计学意义(P>0.05),在第6、9月时差异有统计学意义(P<0.05)。以GOS评分在4分以上、ADL评分在75分以上为临床预后恢复良好,两组临床预后良好率差异虽无统计学意义(P>0.05),但观察组较对照组良好率更高,GOS评分两组良好率分别为70.45%、53.49%,ADL评分两组良好率分别为70.45%、60.47%。结论R-PA联合丁苯肽相比较rt-PA联合丁苯肽治疗急性进展性大脑中动脉缺血性脑卒中患者的远期临床预后更好,作为rt-PA的衍生物,R-PA在急性进展性大脑中动脉缺血性脑卒中的治疗表现出一定的治疗优势。Objective To explore the clinical prognosis after R-PA combined with Butylphthalide soft capsules treating patient with acute progressive MCA cerebral ischemic stroke. Method A total of 87 cases with acute progressive MCA cerebral ischemic stroke from January 1st 2015 to May 31st 2015 were selected via orientation matching. The patients were divided into two groups based on different therapy method. 44 cases in observation group (R-PA group) were performed with R-PA combined with Butylphthalide soft capsules. The other 43 cases in control group (rt-PA group) received rt-PA combined with Butylphthalide soft capsules. The recent clinical prognosis were compared and evaluated by NIHSS scale and forward clinical prognosis by GOS and ADL scale. Results The gender composition, age, the time from onset to receiving treatment, infarct area, and GCS at admission between two groups had no significant difference (P>0.05). There is no difference of NIHSS score between R-PA group and rt-PA group at 2th hour, 24th hour, and 7th day (P>0.05). The difference of NIHSS score between R-PA group and rt-PA group at 1th month was significant(P<0.05). It was lower in R-PA group. The GOS and ADL score were higher in R-PA group than that in rt-PA group at 3th, 6th, 9th month. There was no difference at 3th month (P>0.05), but had a significant difference at 6th, 9th month (P<0.05). GOS score above 4 and ADL score above 75 were considered as favorable prognosis. Although there was no significant difference between in R-PA group and rt-PA group, the favorable prognosis rate was higher in R-PA group than rt-PA group (GOS: 70.45%、53.49%;ADL: 70.45%、60.47%, respectively). Conclusion R-PA combined with Butylphthalide soft capsules treating patient with acute progressive MCA cerebral ischemic stroke has a better forward clinical prognosis than rt-PA combined with Butylphthalide soft capsules. As the rt-PA’s derivate, R-PA is valuable in treating acute progressive MCA cerebral ischemic stroke.

关 键 词：大脑中动脉缺血性脑卒中 瑞替普酶 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]