目的 探討蛭蛇通絡(luò)聯(lián)合阿替普酶治療急性腦梗死的臨床療效。方法 選取2019年11月—2022年6月在定州市人民醫(yī)院住院的120例急性腦梗死患者,隨機(jī)分為對(duì)照組(60例)和治療組(60例)。對(duì)照組患者靜脈滴注注射用阿替普酶,0.9 mg/kg,最大劑量不超過(guò)90 mg,其中10%于1 min內(nèi)靜脈推注完畢,余藥在1 h內(nèi)靜脈泵注。在對(duì)照組的基礎(chǔ)上,治療組口服蛭蛇通絡(luò)膠囊,4粒/次,3次/d。兩組用藥14 d。觀察兩組患者臨床療效,比較治療前后兩組患者癥狀緩解時(shí)間,日常自理能力評(píng)估量表(Barthel)指數(shù)和卒中量表(NIHSS)評(píng)分,血清炎性因子腫瘤壞死因子-α(TNF-α)、神經(jīng)元特異性烯醇化酶(NSE)、白細(xì)胞介素-6(IL-6)和同型半胱氨酸(Hcy)水平,及不良反應(yīng)。結(jié)果 治療后,治療組患者臨床有效率為98.33%,明顯高于對(duì)照組(81.67%,P<0.05)。治療后,治療組臨床癥狀緩解時(shí)間均早于對(duì)照組(P<0.05)。治療后,兩組患者的Barthel指數(shù)評(píng)分明顯升高,而NIHSS評(píng)分明顯降低(P<0.05),且治療組Barthel指數(shù)和NIHSS評(píng)分明顯好于對(duì)照組(P<0.05)。治療后,兩組患者血清炎性因子IL-6、NSE、TNF-α、Hcy水平明顯降低(P<0.05),且治療組明顯低于對(duì)照組(P<0.05)。治療后,治療組不良反應(yīng)總發(fā)生率為6.67%,明顯低于對(duì)照組發(fā)生率(15.00%,P<0.05)。結(jié)論 阿替普酶聯(lián)合蛭蛇通絡(luò)膠囊治療效果確切,可緩解急性腦梗死癥狀,患者神經(jīng)功能損傷程度改善明顯,患者自理能力增強(qiáng),并能降低機(jī)體炎性因子。

Objective To investigate the clinical efficacy of Zhishe Tongluo Capsules combined with ateplase in treatment of acute cerebral infarction.Methods Patients(120 cases) with acute cerebral infarction in Dingzhou People's Hospital from November 2019 to June 2022 were randomly divided into control(60 cases) and treatment(60 cases) group. Patients in the control group was iv administered with Alteplase for injection, 0.9 mg/kg, the maximum dose was no more than 90 mg, 10% of which was injected intravenously within 1 min, and the remaining drugs were pumped within 1 h. Patients in the treatment group were po administered with Zhishe Tongluo Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical evaluation was evaluated, and the relief time of symptom, the scores of Barthel index and NIHSS,levels of inflammatory factors IL-6, NSE, TNF-α, and Hcy, adverse reactions in two groups before and after treatment were compared.Results After treatment, the clinical effective rate of the treatment group was 98.33%, which was significantly higher than that of the control group(81.67%, P<0.05). After treatment, the relief time of clinical symptoms in the treatment group was earlier than that in the control group(P<0.05). After treatment, the Barthel index score in the two groups were significantly increased, while the NIHSS score were significantly decreased(P<0.05), and the Barthel index and NIHSS score in the treatment group were significantly better than those in the control group(P<0.05). After treatment, the levels of serum inflammatory factors IL-6, NSE, TNF-α and Hcy in two groups were significantly decreased(P<0.05), and the level in the treatment group was significantly lower than that in the control group(P<0.05). After treatment, the total incidence of adverse reactions in the treatment group was 6.67%, which was significantly lower than that in the control group(15.00%, P<0.05).Conclusion Ateplase combined with Zhishe Tongluo Capsules has a definite therapeutic effect, which can effectively relieve the symptoms of acute cerebral infarction, improve the degree of neurological injury, enhance the self-care ability and reduce the reaction of inflammatory factors.

R971

河北省中醫(yī)藥管理局科研項(xiàng)目(2019358)