注射用丹参多酚酸联合阿替普酶治疗急性脑梗死后的疗效分析
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摘要
目的观察及探讨急性脑梗死应用阿替普酶溶栓后联合注射用丹参多酚酸治疗的临床效果。方法选取新乡市中心医院2018年1月—2018年6月首发急性脑梗死患者71例,其中对照组患者35例,进行阿替普酶静脉溶栓治疗,治疗组患者36例,在对照组基础上应用注射用丹参多酚酸0.13 g/d,共治疗14 d。对比两组治疗效果及两组分别治疗第7天及第14天的美国国立卫生研究院卒中量表(NIHSS)评分和改良RANKIN量表(MRS)评分进行观察比较。结果治疗组治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗第1天时,NIHSS评分及MRS评分无统计学差异;治疗第7、14天时,两组NIHSS评分均降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗第14天时,观察组NIHSS评分明显低于对照组,差异有统计学意义(P<0.05)。在日常生活能力方面,治疗组与对照组在第7天时,MRS评分无论是组间比较还是组内比较,均无明显差异性;但在第14天时,无论组间比较还是组内比较,MRS评分均有明显的差异性且有显著的统计学意义(P<0.05)。结论急性脑梗死进行阿替普酶溶栓后联合注射用丹参多酚酸治疗能够有效的改善神经功能缺损症状及显著提高日常生活自理能力,尤其在脑梗死1周之后临床效果更加显著,值得临床推广和应用。
Objective To observe and investigate the clinical efficacy of alteplase combined with Salvianolic Acids for Injection for patients with acute cerebral infarction. Methods From January 2018 to June 2018, 71 patients with acute cerebral infarction who underwent intravenous thrombolysis with alteplase were were randomly assigned to treatment group(36 cases) and control group(35 cases). Patients in treatment group received Salvianolic Acids for Injection at 0.13 g/day dosage for 14 days. Patients in the control group were given routine treatment. The scores of the United States national institutes of health stroke scale(NIHSS) and modified RANKIN scale(MRS) after treatment at 7, 14 days were compared between two groups. Results The total effective rate of the treatment group was higher than that of the control group, and the difference was significant(P < 0.05). On the first day of treatment, there was no statistical difference in NIHSS score and MRS score; on the seventh and fourteenth days of treatment, the NIHSS score of both groups decreased, and there was significant difference before and after treatment in the same group(P < 0.05);on the fourteenth day of treatment, the NIHSS score of the observation group was significantly lower than that of the control group(P < 0.05). In terms of daily living ability, there was no significant difference in MRS score between the treatment group and the control group on the 7 th day, but on the 14 th day, there was significant difference in MRS score between the two groups(P < 0.05).Conclusion The treatment of alteplase thrombolysis combined with Salvianolic Acids for Injection for acute cerebral infarction can effectively improve the symptoms of neurological functional defects and significantly improve the ability of self-care in daily life,especially one week later, which is deserved the clinical expansion.
Objective To observe and investigate the clinical efficacy of alteplase combined with Salvianolic Acids for Injection for patients with acute cerebral infarction. Methods From January 2018 to June 2018, 71 patients with acute cerebral infarction who underwent intravenous thrombolysis with alteplase were were randomly assigned to treatment group(36 cases) and control group(35 cases). Patients in treatment group received Salvianolic Acids for Injection at 0.13 g/day dosage for 14 days. Patients in the control group were given routine treatment. The scores of the United States national institutes of health stroke scale(NIHSS) and modified RANKIN scale(MRS) after treatment at 7, 14 days were compared between two groups. Results The total effective rate of the treatment group was higher than that of the control group, and the difference was significant(P < 0.05). On the first day of treatment, there was no statistical difference in NIHSS score and MRS score; on the seventh and fourteenth days of treatment, the NIHSS score of both groups decreased, and there was significant difference before and after treatment in the same group(P < 0.05);on the fourteenth day of treatment, the NIHSS score of the observation group was significantly lower than that of the control group(P < 0.05). In terms of daily living ability, there was no significant difference in MRS score between the treatment group and the control group on the 7 th day, but on the 14 th day, there was significant difference in MRS score between the two groups(P < 0.05).Conclusion The treatment of alteplase thrombolysis combined with Salvianolic Acids for Injection for acute cerebral infarction can effectively improve the symptoms of neurological functional defects and significantly improve the ability of self-care in daily life,especially one week later, which is deserved the clinical expansion.
引文
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[6]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志, 2010, 43(2):16-19.
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[9] Liu L, Wang D, Wong K S, et al. Stroke and stroke care in China:huge burden, significant workload, and a national priority[J]. Stroke, 2011, 42(12):3651-3654.
[10] The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med,1995, 333(24):1581-1587.
[11] Xu A D, Wang Y J, Wang D Z, et al. Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese Stroke Therapy Expert Panel[J]. CNS Neurosci Ther,2013, 19(8):543-548.
[12] Jauch E C, Saver J L, Adams H P J R, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(3):870-947.
[13] Emberson J, Lees K R, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J]. Lancet, 2014, 384(9958):1929-1935.
[14] Asadi H, Dowling R, Yan B, et al. Advances in endovascular treatment of acute ischemic stroke[J].Intern Med J, 2015, 45(8):798-805.
[15]夏静,陈瑞琦,陈旭征,等.总丹参多酚酸预处理对脊髓缺血再灌注损伤的保护作用[J].中华细胞与干细胞杂志(电子版), 2015, 5(2):33-37.
[16]黄旭玲.丹参多酚酸对急性脑梗死患者运动和认知功能的影响[J].中国继续教育杂志, 2015(28):180-181.
[17]王伟.丹参多酚酸对大鼠脑缺血再灌注内质网应激的影响[J].中国老年保健医学, 2018(16):52-54.
[18] Leventhal C, Rafii S, Rafii D, et al. Endothelial trophic support of euronal production and recruitment from the adult mammalian ubependyma[J]. Mol Cell Neurosci,1999, 13(6):450-464.
[2] Fonarow G C, Zhao X, Smith E E, et al. Door-to-needle times for tissue Plasminogen activator administration and clinical outcomes in acute ischemic stroke before and aftera quality improvement initiative[J]. JAMA, 2014,311:1632-1640.
[3] Sturm J W, Dewey H M, Donnan G A, et al. Handicap after stroke:how does it relate to disability,perception of recovery, and stroke subtype:the North East Melbourne Stroke Incidence Study(NEMESIS)[J]. Stroke, 2002,33:762-762.
[4] Ishitsuka K, Kamouchi M, Hata J, et al. High blood pressure after acute ischemic stroke is associated with poor clinical outcomes:Fukuoka Stroke Registry[J].Hypertension, 2014, 63:54-60.
[5]黎连娘,张均田.丹参及其同属植物的水溶性活性成分[J].医学研究通讯, 2001, 30(7):2-4.
[6]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志, 2010, 43(2):16-19.
[7]中华医学会神经病学分会.脑卒中患者临床神经功能缺损程度评分标1995[J].中华经科杂志, 1996, 29(6):381-383.
[8] Wang Y, Liao X, Zhao X, et al. Usingrecombinant tissue plasminogen activator to treat acute ischemic stroke in China:analysis of the results from the Chinese National Stroke Registry(CNSR)[J]. Stroke, 2011, 42(6):1658-1664.
[9] Liu L, Wang D, Wong K S, et al. Stroke and stroke care in China:huge burden, significant workload, and a national priority[J]. Stroke, 2011, 42(12):3651-3654.
[10] The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med,1995, 333(24):1581-1587.
[11] Xu A D, Wang Y J, Wang D Z, et al. Consensus statement on the use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke by the Chinese Stroke Therapy Expert Panel[J]. CNS Neurosci Ther,2013, 19(8):543-548.
[12] Jauch E C, Saver J L, Adams H P J R, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(3):870-947.
[13] Emberson J, Lees K R, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J]. Lancet, 2014, 384(9958):1929-1935.
[14] Asadi H, Dowling R, Yan B, et al. Advances in endovascular treatment of acute ischemic stroke[J].Intern Med J, 2015, 45(8):798-805.
[15]夏静,陈瑞琦,陈旭征,等.总丹参多酚酸预处理对脊髓缺血再灌注损伤的保护作用[J].中华细胞与干细胞杂志(电子版), 2015, 5(2):33-37.
[16]黄旭玲.丹参多酚酸对急性脑梗死患者运动和认知功能的影响[J].中国继续教育杂志, 2015(28):180-181.
[17]王伟.丹参多酚酸对大鼠脑缺血再灌注内质网应激的影响[J].中国老年保健医学, 2018(16):52-54.
[18] Leventhal C, Rafii S, Rafii D, et al. Endothelial trophic support of euronal production and recruitment from the adult mammalian ubependyma[J]. Mol Cell Neurosci,1999, 13(6):450-464.