發(fā)布時間：2018-03-15 00:05

  本文選題：急性腦梗死　切入點：經(jīng)顱多普勒超聲　出處：《中華中醫(yī)藥學刊》2017年10期 　論文類型：期刊論文

【摘要】：目的:觀察經(jīng)顱多普勒超聲輔助動脈溶栓聯(lián)合活血化瘀湯治療急性腦梗死的臨床療效,優(yōu)化臨床治療效果。方法:選取醫(yī)院收治的80例急性腦梗死患者作為觀察對象,采用SPSS 19.0生成隨機數(shù)字表,按入院順序隨機分為研究組40例和對照組40例,對照組給予重組人組織型纖溶酶原激活劑(rt-PA)動脈溶栓,并給予經(jīng)顱多普勒超聲(TCD)輔助溶栓,術后給予雙重抗血小板聚集、擴容、改善血液循環(huán)及神經(jīng)保護等常規(guī)西藥治療,觀察組在對照組的基礎上,術后再口服活血化瘀湯,連續(xù)服用14 d,治療前、治療后7 d、治療后14 d進行神經(jīng)功能缺損評分(NIHSS評分)及日常生活活動能力量表(Barthel指數(shù))評分,治療前后進行血液流變學指標[血細胞比容(HCT)、全血高切黏度(HWBV)、全血低切黏度(LWBV)、血漿黏度(PV)、纖維蛋白原(FIB)]、炎癥因子[白介素-6(IL-6)、超敏-C反應蛋白(hs-CRP)、腫瘤壞死因子-a(TNF-a)]及血漿和肽素(copeptin)檢測,比較兩組臨床療效。結果:研究組和對照組治療后7 d、治療后14d的NIHSS評分均明顯下降(均P0.05),Barthel指數(shù)均明顯升高(均P0.05),但研究組NIHSS評分下降更明顯(均P0.05),Barthel指數(shù)升高更明顯(均P0.05)。研究組治療后HCT、HWBV、LWBV、PV、FIB均明顯下降(均P0.05),對照組僅HWBV、LWBV、PV明顯下降(均P0.05),且研究組HCT、HWBV、LWBV、FIB下降更明顯(均P0.05)。兩組治療后IL-6、hs-CRP、TNF-a、copeptin均明顯下降,但研究組IL-6、hs-CRP、TNF-a、copeptin下降更明顯(P均0.05)。研究組的臨床總有效率為92.5%,對照組為77.5%,差異具有統(tǒng)計學意義(χ~2=11.652,P0.05)。結論:經(jīng)顱多普勒超聲輔助動脈溶栓后再聯(lián)合活血化瘀湯可優(yōu)化臨床治療效果,有效降低炎性因子水平及和肽素水平,改善血液流變學,恢復對病灶腦組織的供血供氧,促進神經(jīng)功能缺損恢復及日常生活能力改善,提高了患者生活質量。
[Abstract]:Objective: to observe the clinical effect of transcranial Doppler ultrasound assisted arterial thrombolysis combined with Huoxue Huayu decoction in the treatment of acute cerebral infarction. According to the order of admission, SPSS 19.0 was randomly divided into study group (n = 40) and control group (n = 40). The control group was treated with recombinant human tissue plasminogen activator (rt-PA) as thrombolytic agent, and with transcranial Doppler ultrasound (TCD) as an assistant thrombolytic agent. After operation, the patients in the observation group were treated with dual anti-platelet aggregation, dilatation, improved blood circulation and nerve protection, and the observation group was treated with Huoxue Huayu decoction for 14 days after operation, on the basis of the control group. 7 days after treatment and 14 days after treatment, the neurological impairment score (NIHSS) and the activity of daily living (ADL) scale (Barthel index) were evaluated. Before and after treatment, the indexes of hemorheology [HCT, HWBV, LWBV, PVN, FIBF], inflammatory factor [IL-6, hs-CRPN, tumor necrosis factor-aox-TNF-a] and hs-CRPU were measured before and after treatment, and the levels of hs-CRPU, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, hs-CRPU, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽, IL-6, hs-CRPU, TNF- 偽 were measured. Plasma and peptide copeptin, Results: the NIHSS scores of the study group and the control group were significantly decreased at 7 days after treatment and 14 days after treatment (all P 0.05) and the NIHSS scores of the study group were significantly lower than those of the control group (P 0.05%, P 0.05) and that of the control group was higher than that of the control group (P < 0.05), but the NIHSS score of the study group was significantly lower than that of the control group (P < 0.05). After treatment, HCTBV and LWBVV PVFIB in the study group were significantly decreased (all P 0.05), while in the control group, only HWBV / LWBVV PV was significantly decreased (all P 0.05), and the HCTV-HWBV LWBVFIB in the study group was significantly lower than that in the control group (P0.05). After treatment, IL-6 hs-CRPTNF-acoptin was significantly decreased in the study group (P < 0.05), and the level of HWBVV in the study group was significantly lower than that in the control group (P < 0.05), and the level of HWBV in the study group was significantly lower than that in the control group (P < 0.05). The total effective rate of the study group was 92.5 and that of the control group was 77.5, the difference was statistically significant (蠂 ~ (2 +) ~ (2) ~ (11.652)) P 0.05.Conclusion: Transcranial Doppler ultrasound assisted arterial thrombolysis and combined with Huoxue Huayu decoction can optimize the clinical therapeutic effect. It can effectively reduce the levels of inflammatory factors and peptide, improve hemorheology, restore blood and oxygen supply to the brain tissue, promote the recovery of nerve function defect and improve the ability of daily living, and improve the quality of life of the patients.
【作者單位】： 萊蕪市人民醫(yī)院;
【基金】：萊蕪市科學技術局項目[(2013)第111,(2014)第086]
【分類號】：R743.3
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本文編號：1613522