丁苯酞注射液治疗不同严重程度的大脑中动脉脑梗死患者的疗效
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摘要
目的观察丁苯酞氯化钠注射液治疗不同严重程度的大脑中动脉狭窄脑梗死患者的疗效。方法将90例发病时间窗≥6 h并且≤24 h的脑梗死患者随机分为治疗组和对照组,治疗组为常规药物加丁苯酞氯化钠注射液治疗14 d,对照组为常规药物治疗14 d。大脑中动脉严重程度根据ASPECTS评分、PWI-DWI、3D-TOF MRA来区分。指标观察在入院当天、14 d不同严重程度两组的NIHSS评分、BI指数及mRS评分。结果 ASPECTS评分、3D-TOF MRA、PWI-DWI分别代表梗死体积大小、大脑中动脉狭窄程度及缺血半暗带。无论ASPECTS评分高低、3D-TOF MRA狭窄程度及PWI-DWI匹配程度如何,治疗组治疗后较治疗前的NIHSS评分、BI指数、mRS评分均有明显差异(P <0.01)。结论丁苯酞氯化钠注射液对大脑中动脉狭窄脑梗死患者梗死体积大的、大脑中动脉狭窄程度重的和缺血半暗带不明显的患者疗效依然显著,提示丁苯酞改善侧枝循环,改善临床预后。
Objective To observe the effects of butylphthalide and sodium butylphthalide chloride injection on cerebral infarction patients with different severity of middle cerebral artery stenosis. Methods A Total of 90 cases of patients with cerebral infarction whose onset time window was more than 6 hours and less than 24 hours were randomly divided into treatment group and control group. The treatment group was given conventional drugs with butyl phthalide and sodium chloride injection treatment for 14 days, but the control group was only given routine drug treatment for 14 days. The severity of middle cerebral artery was distinguished by ASPECTS score, pwi-dwi, and 3d-tof MRA. The NIHSS score, BI index and m RS score of the two groups with different severity were observed on the day of admission and 14 days after admission. Results ASPECTS score, 3d-tof MRA(degree of blood flow patency) and pwi-dwi respectively represented infarction volume, middle cerebral artery stenosis and ischemic penumbra. Regardless of matching degrees of ASPECTS score, 3d-tof MRA stenosis degree and pwi-dwi, there were significant differences in NIHSS scores,BI index and m RS scores in treatment group between the before and after treatment data(P < 0.01). Con clus ion Butylphthalide and sodium chloride injection on brain artery stenosis has significant effects in patients with big volume cerebral infarction,severe degree middle cerebral artery stenosis and patients with no obvious ischemic penumbra. It shows that butylphthalide improves collateral circulation and improves clinical outcomes.
Objective To observe the effects of butylphthalide and sodium butylphthalide chloride injection on cerebral infarction patients with different severity of middle cerebral artery stenosis. Methods A Total of 90 cases of patients with cerebral infarction whose onset time window was more than 6 hours and less than 24 hours were randomly divided into treatment group and control group. The treatment group was given conventional drugs with butyl phthalide and sodium chloride injection treatment for 14 days, but the control group was only given routine drug treatment for 14 days. The severity of middle cerebral artery was distinguished by ASPECTS score, pwi-dwi, and 3d-tof MRA. The NIHSS score, BI index and m RS score of the two groups with different severity were observed on the day of admission and 14 days after admission. Results ASPECTS score, 3d-tof MRA(degree of blood flow patency) and pwi-dwi respectively represented infarction volume, middle cerebral artery stenosis and ischemic penumbra. Regardless of matching degrees of ASPECTS score, 3d-tof MRA stenosis degree and pwi-dwi, there were significant differences in NIHSS scores,BI index and m RS scores in treatment group between the before and after treatment data(P < 0.01). Con clus ion Butylphthalide and sodium chloride injection on brain artery stenosis has significant effects in patients with big volume cerebral infarction,severe degree middle cerebral artery stenosis and patients with no obvious ischemic penumbra. It shows that butylphthalide improves collateral circulation and improves clinical outcomes.
引文
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[14]LI J,LI Y,OGLE M,et al.dl-3-n-Butylphthalide prevents neuronal cell death after focal cerebral ischemia in mice via the JNK pathway[J].Brain Research,2010,1359(1359):216-226.
[15]SUN Y,XI C,WANG H,et al.dl-3-n-butylphthalide promotes neuroplasticity and motor recovery in stroke rats[J].Behavioural Brain Research,2017,329(329):67.
[16]李鹏翔,苏庆杰,蔡毅等。丁苯酞注射液治疗急性脑梗死临床研究[J].昆明医科大学学报,2014,35(8):103-105
[17]孙元元.丁苯酞注射液对责任动脉重度狭窄或闭塞的脑梗死患者脑血流的改善作用[D].长春:吉林大学硕士学位论文,2016.
[18]LIU C L,LIAO S J,ZENG J S,et al.dl-3n-butylphthalide prevents stroke via improvement of cerebral microvessels in RHRSP[J].Journal of the Neurological Sciences,2007,260(1):106-113.
[19]王丹,郑辐,黄芩,等.超敏C反应蛋白、纤维蛋白原与脑梗死患者颈动脉粥样硬化的相关性分析[J].昆明医科大学学报,2014,35(8):103-105.
[2]中华医学会神经病学分会.中国缺血性脑卒中风险评估量表使用专家共识[J].中华神经科杂志,2016,49(7):519-525.
[3]KITAGAWA K,SAITOH M,ISHIZUKA K,et al.Remote limb ischemic conditioning during cerebral ischemia reduces infarct size through enhanced collateral circulation in murine focal cerebral ischemia[J].J Stroke Cerebrovasc Dis,2018,27(4):831-838.
[4]TONG L S,GUO Z N,OU Y B,et al.Cerebral venous collaterals:a new fort for fighting ischemic stroke?[J].Progress in Neurobiology,2017,16(3):172-193.
[5]GINSBERG MD.Expanding the concept of neuroprotection for acute ischemic stroke:The pivotal roles of reperfusion and the collateral circulation[J].Progress in Neurobiology,2016,145(145):46-77.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[7]刘信东,王欣,曹秋菊,等.丁苯酞对急性脑梗死患者侧支循环的影响[J].西南国防医药,2018,28(2):117-120.
[8]XIONG Z,LU W,ZHU L,et al.Dl-3-n-Butylphthalide treatment enhances hemodynamics and ameliorates memory deficits in rats with chronic cerebral hypoperfusion[J].Frontiers in Aging Neuroscience,2017,9(9):238.
[9]田云玉,易继平,姚晓喜,等.丁苯酞注射液治疗急性脑梗死的临床疗效[J].中国实用神经疾病杂志,2014,17(4):14-16.
[10]俞小梅,王喜丰,张静,等.丁苯酞注射液及丁苯酞胶囊治疗急性脑梗死患者的临床疗效对比[J].实用医学杂志,2016,32(17):2921-2924.
[11]朱永林,李晓晓,杨伟琴.丁苯酞联合纤溶酶治疗急性脑梗死患者的临床疗效[J].中华老年医学杂志,2018,37(1):45-48.
[12]LI L,ZHANG B,TAO Y,et al.DL-3-n-butylphthalide protects endothelial cells against oxidative/nitrosative stress,mitochondrial damage and subsequent cell death after oxygen glucose deprivation in vitro.[J].Brain Research,2009,1290(1290):91-101.
[13]ZHAO H,YUN W,ZHANG Q,et al.Mobilization of circulating endothelial progenitor cells by dl-3-n-butylphthalide in acute ischemic stroke patients[J].J Stroke Cerebrovasc Dis,2016,25(4):752-760.
[14]LI J,LI Y,OGLE M,et al.dl-3-n-Butylphthalide prevents neuronal cell death after focal cerebral ischemia in mice via the JNK pathway[J].Brain Research,2010,1359(1359):216-226.
[15]SUN Y,XI C,WANG H,et al.dl-3-n-butylphthalide promotes neuroplasticity and motor recovery in stroke rats[J].Behavioural Brain Research,2017,329(329):67.
[16]李鹏翔,苏庆杰,蔡毅等。丁苯酞注射液治疗急性脑梗死临床研究[J].昆明医科大学学报,2014,35(8):103-105
[17]孙元元.丁苯酞注射液对责任动脉重度狭窄或闭塞的脑梗死患者脑血流的改善作用[D].长春:吉林大学硕士学位论文,2016.
[18]LIU C L,LIAO S J,ZENG J S,et al.dl-3n-butylphthalide prevents stroke via improvement of cerebral microvessels in RHRSP[J].Journal of the Neurological Sciences,2007,260(1):106-113.
[19]王丹,郑辐,黄芩,等.超敏C反应蛋白、纤维蛋白原与脑梗死患者颈动脉粥样硬化的相关性分析[J].昆明医科大学学报,2014,35(8):103-105.