续命通脉汤联合替罗非班治疗静脉溶栓后早期神经功能恶化的急性缺血性卒中患者的临床疗效  

The efficacy of Xumingtongmai decoction combined with Tirofiban in the treatment of early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：冉丽 曾子修 官玥玥 唐军[1] RAN Li;ZENG Zixiu;GUAN Yueyue;TANG Jun(Department of Neurology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]重庆市中医院神经内科,重庆400021

出　　处：《现代医药卫生》2025年第1期57-61,共5页Journal of Modern Medicine & Health

基　　金：“重庆英才计划”项目(创新领军人才)(渝委人才〔2021〕5号);重庆市巴渝岐黄学者(渝中医〔2023〕23号)。

摘　　要：目的探讨续命通脉汤联合替罗非班治疗静脉溶栓后早期神经功能恶化的急性缺血性卒中(AIS)患者的临床疗效及安全性。方法纳入2020年1月至2023年12月该院卒中单元收治的接受静脉溶栓治疗,并在治疗24 h内出现神经功能恶化的AIS患者,共52例,采用随机数字表法将其分为联合治疗组和常规治疗组。常规治疗组为静脉予以替罗非班治疗24 h,联合治疗组在替罗非班治疗基础上予以续命通脉汤联合治疗。分别于治疗前及治疗14 d后,对2组患者的美国国立卫生研究院卒中量表(NIHSS)评分、改良运动功能(mRS)评分、Barthel指数(BI)评分、血清神经元特异性烯醇化酶(NSE)、S100B蛋白浓度等多个维度进行评估,并以90 d mRS评分判定患者远期预后。结果与治疗前相比,2组患者治疗14 d后NIHSS评分、mRS评分、BI评分均明显改善,NSE及S100B水平均显著降低,且联合治疗组患者上述指标改善情况优于常规治疗组,差异均有统计学意义(P<0.05)。随访90 d,联合治疗组患者远期神经功能预后良好(mRS≤2分)比例高于常规治疗组[88.5%(23/26)vs.65.4%(17/26)],差异有统计学意义(P<0.05)。结论续命通脉汤与替罗非班联合治疗可显著改善静脉溶栓后早期神经功能恶化的AIS患者神经功能缺损症状,具有临床应用价值。Objective To investigate the clinical efficacy and safety of Xumingtongmai(XMTM)decoction combined with Tirofiban in the treatment of acute ischemic stroke(AIS)patients with early neurological deterioration(END)after intravenous thrombolysis(IVT).Methods A total of 52 patients with AIS who received intravenous thrombolytic therapy and suffered from neurological deterioration within 24 hours after treatment were included in the stroke unit of our hospital from January 2020 to December 2023.They were divided into the combined treatment group and the conventional treatment group by random number table method.The conventional treatment group was treated with intravenous Tirofiban for 24 h,and the combined treatment group was treated with XMTM decoction on the basis of Tirofiban treatment.The National Institute of Health stroke scale(NIHSS)score,Modified Rankin Scale(mRS),Barthelindex(BI)score,serum neuron-specific enolase(NSE)and S100B protein concentration and other dimensions of the two groups were evaluated before and 14 days after treatment,and the mRS score was followed up for 90 days to determine the long-term prognosis of the patients.Results Compared with before treatment,NIHSS score,mRS Score and BI score of two groups were significantly improved after 14 days of treatment(P<0.05).NSE and S100B levels were significantly decreased before treatment and the improvement of the above indicators in the combined treatment group was better than that in the conventional treatment group,with statistical significance(P<0.05).After 90 days of follow-up,the proportion of the combined treatment group with better functional outcome(mRS≤2 points)was higher than that in the conventional treatment group[88.5%(23/26)vs.65.4%(17/26)],and the difference was statistically significant(P<0.05).Conclusion XMTM decoction combined with Tirofiban can significantly improve the neurological deficits in AIS patients with END after IVT,which has clinical application value.

关 键 词：续命通脉汤 替罗非班 急性缺血性卒中 早期神经功能恶化 静脉溶栓 

分 类 号：R255.2[医药卫生—中医内科学]