生脉注射液对轻中度脑梗死超时间窗rt-PA溶栓患者预后的影响
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篇名: 生脉注射液对轻中度脑梗死超时间窗rt-PA溶栓患者预后的影响
TITLE:
摘要: 目的:探讨生脉注射液对电子计算机断层扫描(CT)指导下轻中度脑梗死超时间窗注射用阿替普酶(rt-PA)溶栓患者预后的影响。方法: 168例超时间窗的轻中度脑梗死患者按随机数字表法分为对照组(84例)和观察组(84例)。对照组患者给予rt-PA(0.9 mg/kg),将使用总剂量10%的rt-PA在1 min内静脉推注入患者体内,剩余90%的药物加入0.9%氯化钠注射液250 ml中静脉滴注(持续时间不短于1 h),溶栓治疗24 h后行CT检查,复查确认无脑内出血后给予口服阿司匹林300 mg/d,连用10 d,后改为100 mg/d继续口服90 d,同时,酌情给予他汀类调脂药、钙拮抗药、β受体阻滞药、硝酸酯类药。观察组患者在对照组治疗的基础上加用生脉注射液40 ml加入5%葡萄糖注射液250 ml中静脉滴注,每天1次,连用28 d。观察两组患者的美国国立卫生研究院卒中量表(NIHSS)评分、改良的Rankin评分、日常生活能力表-巴氏指数(Barthel)评分变化和溶栓治疗后48 h内症状性颅内出血情况、继发性出血情况、住院时间、术后3个月死亡情况及不良反应发生情况。结果:治疗前,两组患者NIHSS评分、改良的Rankin评分、Barthel评分比较,差异均无统计学意义(P>0.05)。治疗6 h、24 h、7 d后两组患者NIHSS评分显著低于同组治疗前,且治疗24 h、7 d后观察组低于对照组;治疗3个月后两组患者改良的Rankin评分显著低于同组治疗前,且观察组低于对照组;治疗3个月后两组患者Barthel评分显著高于同组治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患者住院时间显著短于对照组,术后3个月死亡率显著低于对照组,差异均有统计学意义(P<0.05)。两组患者治疗期间未见明显不良反应发生。结论:在常规治疗的基础上加用生脉注射液对CT指导下轻中度脑梗死超时间窗rt-PA溶栓患者预后有改善作用,可降低NIHSS评分、改良的Rankin评分,提高Barthel评分,缩短住院时间,降低术后3个月死亡率,且安全性较好。
ABSTRACT: OBJECTIVE: To explore the prognosis effect of Shengmai injection to the rt-PA thrombolysis on broadened therapeutic window patients of mild-to-moderate cerebral infarction under the guidance of computer tomography(CT). METHODS: 168 patients with mild-to-moderate cerebral infarction were randomly divided into control group (84 cases) and observation group (84 cases). Control group received rt-PA (0.9 mg/kg), and 10% of the total rt-PA was mixed and injected into patients within 1 min, the rest 90% adding into 250 ml 0.9% Sodium chloride injection (no less than 1 h), CT was performed after 24 h thrombolytic therapy, and the patients with no intracerebral hemorrhage in re-examination received 300 mg/d aspirin for 10 d, then 100 mg/d for 90 d, and appropriate statins, calcium antagonists, β-blockers and nitrates; observation group additionally received 40 ml Shengmai injection, adding into 250 ml 5% Glucose injection, intravenous infusion, once a day, for 28 d. National Institutes of Health Stroke Scale (NIHSS) score, Rankin score, daily living-Barthel Index (Barthel) score, rate of symptomatic intracranial hemorrhage, rate of secondary hemorrhage, hospitalization time, 3-month postoperative mortality and incidence of adverse reactions in 2 groups were observed. RESULTS: Before treatment, there were no significant differences in the NIHSS score, Rankin score and Barthel score (P>0.05). The NIHSS score in 2 groups after 6 h, 24 h and 7 d were significantly lower than before, and observation group was lower than control group after 24 h and 7 d;Rankin score after 3 months was significantly lower than before, and observation group was lower than control group; Barthel score after 3 months was significantly higher than before, and observation group was higher than control group, The differences were statistically significant (P<0.05). The hospitalization time in observation group was significantly shorter than in control group, and 3-month postoperative mortality was significantly lower than control group, the differences were statistically significant (P<0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS: Based on conventional treatment, Shengmai injection has improvement in the rt-PA intravenous thrombolysis on broadened therapeutic window patients of mild-to-moderate cerebral infarction under the guidance of CT, it can reduce NIHSS score and Rankin score, increase Barthel score, shorten hospitalization time and reduce the 3-month postoperative mortality, with good safety.
期刊: 2016年第27卷第21期
作者: 张卫国,王素洁,刘海燕
AUTHORS: ZHANG Weiguo,WANG Sujie,LIU Haiyan
关键字: 生脉注射液;轻中度脑梗死;超时间窗;注射用阿替普酶;溶栓;预后
KEYWORDS: Shengmai injection; Mild-to-moderate cerebral infarction; Beyond the optimal time-window;rt-PA thrombolysis; Thrombolytic; Prognosis
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