丁苯酞注射液辅治急性脑梗死患者的效果观察及对脑血管储备功能、侧支代偿血管建立的影响  

Effect of Butylphthalide Injection in the Adjuvant Treatment of Acute Cerebral Infarction and Its Influence on Cerebrovascular Reserve and the Establishment of Collateral Compensatory Vessels

作　　者：邢金梅 王素玉[1] 崔秀卿 刘树理[1] 张玉凤[1] XING Jin-mei;WANG Su-yu;CUI Xiu-qing;LIU Shu-li;ZHANG Yu-feng(Department of Geriatrics,the Second Hospital of Baoding,Baoding,Hebei 071000,China)

机构地区：[1]保定市第二医院老年病科,河北保定071000

出　　处：《临床误诊误治》2020年第7期43-48,共6页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科技计划项目(18ZF016)。

摘　　要：目的探究丁苯酞注射液辅治急性脑梗死的临床效果及对脑血管储备功能(cerebrovascular reserve, CVR)、侧支代偿血管建立的影响。方法选取我院2018年2月-2019年1月收治的83例存在手术或溶栓治疗禁忌证的急性脑梗死患者,根据治疗方法的不同分为观察组42例和对照组41例。入院后,两组均给予脑梗死常规治疗,观察组在此基础上加用丁苯酞注射液每日2次静脉滴注,两组疗程均为2周。比较两组治疗前后美国国立卫生研究院卒中量表(national institutes of health stroke scale, NIHSS)评分及Barthel指数(BI),治疗后临床疗效,治疗前后CVR值和脉动指数(PI),治疗后侧支循环建立情况及治疗前后相关因子[血清血管内皮生长因子(VEGF)、重组碱性成纤维细胞生长因子(bFGF)、脑源性神经营养因子(BDNF)]水平,以及治疗期间不良反应。结果与治疗前相比,两组治疗后NIHSS评分降低,而BI升高,且观察组治疗后NIHSS评分、BI改善程度大于对照组,差异均有统计学意义(P<0.05或P<0.01)。治疗后,观察组总有效率为88.10%高于对照组的63.41%(χ2=6.910,P=0.009)。治疗后,两组PI降低、CVR值升高,且观察组PI降低及CVR值升高程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。治疗后,观察组侧支循环建立率为61.90%高于对照组的39.02%(χ2=5.633,P=0.012);治疗后,两组血清VEGF、bFGF、BDNF水平均升高,且观察组上述指标升高程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组治疗期间总不良反应发生率比较差异无统计学意义(χ2=0.862,P=0.353)。结论丁苯酞注射液辅治急性脑梗死的效果显著,可减轻患者神经功能缺损程度,改善生活自理能力,提高CVR,增加侧支代偿血管建立,且治疗安全性良好。Objective To explore the clinical effect of butylphthalide injection in the adjuvant treatment of acute cerebral infarction(ACI) and its effect on the cerebrovascular reserve(CVR) and establishment of collateral compensatory vessels. Methods From February 2018 to January 2019, 83 patients with ACI who were treated in our hospital and had contraindications of operation or thrombolysis were selected and divided into observation group(n=42) and control group(n=41). After admission, the two groups were given conventional medical treatment for ACI. On this basis, the observation group was supplemented with intravenous injection of butylphthalide twice a day. The course of treatment in both groups was 2 weeks. Before and after treatment, neurological deficit score [national institutes of health stroke scale(NIHSS) score and recovery of ability of daily activity [Barthel Index(BI)] were compared between the two groups. Clinical efficacy after treatment, CVR and pulsatility index(PI) before and after treatment, establishment of collateral circulation and levels of related indexes [serum vascular endothelial growth factor(VEGF), recombinant basic fibroblast growth factor(bFGF), brain-derived neurotrophic factor(BDNF)] as well as adverse reactions during the treatment were compared. Results Compared with those before treatment, the NIHSS score of the two groups was decreased, while BI was increased. The improvement of NIHSS score and BI in the observation group was greater than that in the control group(P<0.05 or P<0.01). After treatment, the total effective rate of the observation group was 88.10%, which was higher than 63.41% of the control group(χ2=6.910, P=0.009). After treatment, PI was decreased while CVR was increased in the two groups, and the decrease and increase were more significant in the observation group than in the control group(P<0.05 or P<0.01). After treatment, the establishment rate of collateral circulation in the observation group was 61.90% higher than 39.02% in the control group(χ2=5.633, P=0.012)

关 键 词：脑梗死 丁苯酞 脑血管储备功能 侧支代偿血管建立 脉动指数 血管内皮生长因子 

分 类 号：R743.33[医药卫生—神经病学与精神病学]