本文選題：卒中　切入點(diǎn)：腦缺血　出處：《中國(guó)現(xiàn)代神經(jīng)疾病雜志》2016年11期 　論文類型：期刊論文

【摘要】：目的探討三七總皂苷對(duì)急性缺血性卒中患者重組組織型纖溶酶原激活物(rt-PA)靜脈溶栓療效和出血性轉(zhuǎn)化的影響。方法共200例急性(發(fā)病至入院時(shí)間4.50 h)缺血性卒中患者采用隨機(jī)數(shù)字表法隨機(jī)分為常規(guī)rt-PA靜脈溶栓組(對(duì)照組,100例)和rt-PA靜脈溶栓聯(lián)合三七總皂苷治療組(治療組,100例),分別于治療前、靜脈溶栓后24 h和14 d檢測(cè)缺血-再灌注損傷指標(biāo)[丙二醛(MDA)、超氧化物歧化酶(SOD)]、出血性轉(zhuǎn)化指標(biāo)[基質(zhì)金屬蛋白酶-9(MMP-9)、纖維連接蛋白(FN)]和神經(jīng)功能指標(biāo)[美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)、Barthel指數(shù)(BI)],觀察靜脈溶栓后14 d藥物不良反應(yīng)和出血性轉(zhuǎn)化發(fā)生率,評(píng)價(jià)靜脈溶栓后12個(gè)月預(yù)后(病死率和BI評(píng)分)。結(jié)果治療組患者血清SOD(P=0.000)和BI評(píng)分(P=0.000)高于,血清MDA(P=0.001)和MMP-9(P=0.001)、血漿FN(P=0.000)和NIHSS評(píng)分(P=0.006)低于對(duì)照組。rt-PA靜脈溶栓聯(lián)合三七總皂苷治療后24 h,血清MDA(P=0.000)和MMP-9(P=0.000)、BI評(píng)分(P=0.000)升高,NIHSS評(píng)分降低(P=0.000);治療后14 d,血清MDA(P=0.000)和MMP-9(P=0.000)反而降低,血清SOD(P=0.000)和BI評(píng)分(P=0.000)持續(xù)升高,血漿FN(P=0.000)和NIHSS評(píng)分(P=0.000)持續(xù)降低。靜脈溶栓后14 d,治療組患者出血性轉(zhuǎn)化發(fā)生率低于對(duì)照組[9例(9%)對(duì)19例(19%);χ2=4.153,P=0.042)],藥物不良反應(yīng)發(fā)生率組間差異無統(tǒng)計(jì)學(xué)意義[14例(14%)對(duì)11例(11%);χ2=0.411,P=0.521]。靜脈溶栓后12個(gè)月,兩組病死率差異無統(tǒng)計(jì)學(xué)意義[5例(5%)對(duì)1例(1%);χ2=1.546,P=0.241],而治療組生存患者BI評(píng)分高于對(duì)照組(88.51±11.49對(duì)84.47±9.83;t=2.451,P=0.015)。結(jié)論三七總皂苷可以減輕急性缺血性卒中患者rt-PA靜脈溶栓后缺血-再灌注損傷,降低出血性轉(zhuǎn)化發(fā)生率,改善患者預(yù)后,且安全性良好。
[Abstract]:Objective to investigate the effects of panax notoginseng saponins on intravenous thrombolysis and hemorrhagic transformation of recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke. The patients were randomly divided into routine rt-PA intravenous thrombolytic group (control group, n = 100) and rt-PA intravenous thrombolytic therapy combined with panax notoginseng saponins group (treatment group, n = 100). The indexes of ischemia-reperfusion injury [malondialdehyde (MDA), superoxide dismutase (SOD)], hemorrhagic transformation index [matrix metalloproteinase-9 (MMP-9), fibronectin (FN)] and neurological function were detected 24 h and 14 d after intravenous thrombolysis. NIHSS and Barthel Index (BI) were used to observe the adverse drug reactions and the incidence of hemorrhagic transformation 14 days after intravenous thrombolysis. Results the prognosis (mortality and BI score) of 12 months after intravenous thrombolysis were higher in the treatment group than in the treatment group. Serum MDA-P0. 001) and MMP-9 P0. 001) and NIHSS score (P 0. 006) were lower than those in control group 24 h after intravenous thrombolytic thrombolysis combined with total saponins of Panax notoginseng (0. 000) and MMP-9 P0. 000BI score P0. 000) increased and decreased significantly (P 0. 000), and serum MDA-P0. 000) and MMP-9 P0. 000) decreased at 14 days after treatment. Serum SODX (0.000) and BI score (P = 0.000) continued to increase. The incidence of hemorrhagic transformation in the treatment group was significantly lower than that in the control group [9 cases, 9 cases) and 19 cases, respectively; 蠂 2 + 4.153% P + 0. 042]. There was no significant difference in the incidence of adverse drug reactions between the two groups [14 cases (14 cases) and 11 cases (14 cases, 14 cases), respectively], and there was no significant difference in the incidence of adverse drug reactions between the two groups [14 cases, 14 cases, 14 cases], 11 cases, respectively, but no significant difference in the incidence of adverse drug reactions between the two groups (14 cases, 14 cases). 11%. 12 months after intravenous thrombolysis, 蠂 2 0. 411 P 0. 521. There was no significant difference in fatality rate between the two groups [5 cases with 5 cases) and 1 case with acute ischemic stroke. The BI score of survival patients in the treatment group was higher than that in the control group (88.51 鹵11.49 vs 84.47 鹵9.83). Conclusion Panax saponins can reduce the ischemia-reperfusion injury after intravenous thrombolytic therapy in patients with acute ischemic stroke, but the BI score in the treatment group is higher than that in the control group (88.51 鹵11.49 vs 84.47 鹵9.83). Reduce the incidence of hemorrhagic transformation, improve the prognosis of patients, and the safety is good.
【作者單位】： 河南省信陽市中心醫(yī)院神經(jīng)內(nèi)科;
【分類號(hào)】：R743.3

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