天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (3): 296-300.doi: 10.11958/20210957

• 临床研究 • 上一篇    下一篇

阿替普酶静脉溶栓联合丁苯酞治疗对急性重症脑梗死患者神经和凝血功能的影响

谢涛波，钟纯正，符尧天，王国卿，米东华   

  1. 1海南省儋州市人民医院神经内科（邮编571799）；2儋州市农垦医院神经内科；3海南省儋州市人民医院精神病科；4首都医科大学附属北京天坛医院神经重症医学科
  • 收稿日期:2021-04-22 修回日期:2021-10-08 出版日期:2022-03-15 发布日期:2022-03-15
  • 基金资助:
    国家自然科学基金资助项目（81601015）

Effects of alteplase intravenous thrombolysis combined with butylphthalide on neurological function and coagulation function in patients with acute severe cerebral infarction

XIE Taobo, ZHONG Chunzheng, FU Yaotian, WANG Guoqing, MI Donghua   

  1. 1 Department of Neurology, Danzhou People's Hospital, Danzhou 571799, China; 2 Department of Neurology, Danzhou Nongken Hospital; 3 Department of Psychiatry, Danzhou People's Hospital; 4 Department of Neurology and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University
  • Received:2021-04-22 Revised:2021-10-08 Published:2022-03-15 Online:2022-03-15

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摘要： 目的　探讨阿替普酶静脉溶栓联合丁苯酞治疗对急性重症脑梗死患者神经功能和凝血功能的影响。方法　120例急性重症脑梗死患者根据治疗方式不同分为对照组与观察组，各60例。对照组采用阿替普酶静脉溶栓治疗，观察组采用阿替普酶静脉溶栓联合丁苯酞治疗，连续治疗14 d。比较2组疗效和美国国立卫生院神经功能缺损评分（NIHSS），采用全自动凝血分析仪测定凝血功能，采用高效液相色谱法测定神经递质水平，采用脑灌注CT检查脑血流灌注量变化，并记录2组治疗期间不良反应发生率。结果　观察组临床疗效和总有效率优于对照组（P＜0.05）；2组患者治疗后NIHSS较治疗前降低，且观察组低于对照组（P＜0.05）；观察组治疗后血清凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、多巴胺（DA）、5-羟色胺（5-HT）、脑血流量（CBF）、脑血容量（CBV）值高于对照组，纤维蛋白原（FIB）、平均通过时间（MTT）值低于对照组（均P＜0.05）；2组治疗期间不良反应发生率（11.67% vs. 8.33%）差异无统计学意义。结论　阿替普酶静脉溶栓联合丁苯酞治疗可有效改善急性重症脑梗死患者脑血流灌注和凝血功能，促进神经功能修复和重建，且安全性高，值得临床推荐。

关键词: 组织型纤溶酶原激活物, 脑梗死, 神经康复, 血液凝固试验, 丁苯酞, 急性重症脑梗死, 脑血流灌注量

Abstract: Objective　To investigate the effect of intravenous thrombolysis with alteplase combined with butylphthalide on neurological function and coagulation function in patients with acute severe cerebral infarction. Methods　A total of 120 patients with acute severe cerebral infarction were divided into the control group and the observation group according to different treatment methods, with 60 cases in each group. The control group was treated with alteplase intravenous thrombolysis, and the observation group was treated with alteplase intravenous thrombolysis combined with butylphthalide for 14 days. The curative effects and the National Institutes of Health Neurological Deficit Score (NIHSS) were compared between the two groups. The coagulation function was measured by automatic coagulation analyzer, and the neurotransmitter level was measured by high performance liquid chromatography. Changes of cerebral blood flow perfusion were detected by cerebral perfusion CT, and the incidence of adverse reactions during treatment was recorded in the two groups of patients. Results　The clinical efficacy and total effective rate were better in the observation group than those of the control group (P＜0.05). The NIHSS of the two groups were significantly lower after treatment than those before treatment, and the decrease was more significant in the observation group (P＜0.05). The values of serum prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), dopamine (DA), serotonin (5-HT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were higher in the observation group than those in the control group (P＜0.05), and the values of fibrinogen (FIB) and mean transit time (MTT) were lower than those in the control group (P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups (11.67% vs. 8.33%, P＞0.05). Conclusion Intravenous thrombolysis with alteplase combined with butylphthalide can effectively improve cerebral blood flow perfusion and coagulation function in patients with acute severe cerebral infarction, promote the repair and reconstruction of neurological function, and has high safety, which is worthy of clinical recommendation.

Key words: tissue plasminogen activator, brain infarction, neurological rehabilitation, blood coagulation tests, butylphthalide, acute severe cerebral infarction, cerebral blood flow perfusion