本文選題：丁苯酞注射液　切入點：進展性腦梗死　出處：《南京醫(yī)科大學》2016年博士論文

【摘要】：腦梗死(Cerebral infarction,CI)是神經(jīng)內科常見的缺血性腦血管病,是嚴重危害人民群眾健康主要疾病之一,尤其進展性腦梗死(Progressive cerebral infarction,PCI)在臨床上具有進展快,致死率及致殘率遠較一般腦梗死為高等特點,且難以預測,治療上也很棘手,容易引發(fā)醫(yī)患矛盾。因此,探討進展型腦梗死治療方法,改善進展性腦梗死的預后是臨床重要任務之一。研究目的探討丁苯酞對進展性腦梗死臨床療效及CD34+細胞水平、hs-CRP濃度、顱內平均血流速度及搏動指數(shù),評估丁苯酞對進展性腦梗死的治療作用,為臨床治療PCI提供新思路。研究方法根據(jù)美國國立衛(wèi)生研究院卒中量表(NIHSS)進行評分,收集2012年9月至2015年12月在江蘇省淮安市第二人民醫(yī)院神經(jīng)內科住院的進展性腦梗死患者82例,隨機分為兩組,治療組42例,對照組40例。對照組給予抗血小板聚集、他汀類藥物應用、控制血壓、調節(jié)血糖及改善腦循環(huán)等治療,治療組在對照組基礎上給予丁苯酞100ml(25mg)應用,每日2次,應用時限為連續(xù)應用14d。通過NIHSS評分對比治療組和對照組二周后神經(jīng)功能缺損改善程度;改良的RANKIN(Modified Rankin Scale,MRS)觀察治療后90天病情恢復情況;經(jīng)顱多普勒(Transcranial doppler,TCD)檢測腦血流大腦中動脈(Middle cerebral artery,MCA)和大腦后動脈(Posterior cerebral artery,PCA)平均速度(Mean Velocity,Vm)和搏動指數(shù)(Pulse index,PI),觀察顱內腦血流及血管阻力情況流式細胞儀檢測CD34+細胞,觀察丁苯酞對顱內血管新生、側支循環(huán)改善情況;采用膠乳增強的免疫比濁法檢測hs-CRP水平,判定丁苯酞對進展性腦梗死對缺血引起炎癥的控制情況;。研究結果1.入院后腦梗死進展發(fā)生前,治療組NIHSS評分基線分為6.78±3.22,對照組7.07±3.93,兩組比較,P0.05,無統(tǒng)計學差異;進展后,治療組NIHSS評分為15.53±4.47,對照組15.79±4.21,兩組NIHSS比較,P0.05,差異無統(tǒng)計學意義。2.治療組丁苯酞治療后二周后NIHSS評分7.02±2.98;對照組治療后二周10.47±2.53。治療組和對照組NIHSS比較,P0.05,差異顯著,有統(tǒng)計學意義。3.治療二周后,對照組基本痊愈2,顯著改善7例,改善19例,無效8例,惡化4例,死亡0例,有效率為22.5%;治療組基本痊愈6,顯著改善22例,改善10例,無效3例,惡化1例,死亡0例,有效率為66.67%,兩組比較P0.05,差異有統(tǒng)計學意義。4.兩組MRS比較,進展時,u =0.84,P0.05,兩組比較無統(tǒng)計學差異;治療90天后,u=18.4,P0.05 P0.05,差異有統(tǒng)計學意義。5.進展發(fā)生時,治療組大腦中動脈Vm為44.68±7.43,對照組Vm為45.02±7.33;治療組PI為0.83±0.11,對照組PI為0.82±0.12,兩組比較,差異無統(tǒng)計學意義。治療二周后,治療組大腦中動脈Vm為53.56±7.62,對照組Vm為47.38±7.31;治療組PI為0.68±0.11,對照組0.76±0.13,兩組比較,Vm及PI均有差異,有統(tǒng)計學意義,P0.05。6.進展發(fā)生時,治療組大腦后動脈Vm為31.23±2.63,對照組Vm為30.98±2.72;治療組PI為0.84±0.12,對照組PI為0.83±0.13,兩組比較,差異無統(tǒng)計學意義。治療二周后,治療組大腦后動脈Vm為38.72±3.07,對照組Vm為33.53±2.98;治療組PI為0.71±0.11,對照組0.77±0.12,兩組比較,Vm及PI均有差異,有統(tǒng)計學意義,P0.05。7.治療前,治療組CD34+細胞0.035±0.06%,對照組0.036±0.08%,兩組之間比較,P0.05,差異無統(tǒng)計學意義;治療二周后,治療組CD34+細胞0.054±0.08%,對照組0.040±0.09%,兩組比較,P0.05,有統(tǒng)計學意義。8.治療前,治療組患者hs-CRP濃度13.56±3.88m/L,對照組為13.49±3.92mg/L,兩組之間比較,P0.05,差異無統(tǒng)計學意義。治療二周后,治療組hs-CRP 濃度 8.47.±2.72mg/L,對照組 10.53±2.69mg/L,P0.05,有統(tǒng)計學意義。結論應用丁苯酞注射液治療進展性腦梗死后,可明顯減輕患者的神經(jīng)功能缺損,改善患者的近期療效;可改善患者的MRS評分,改善患者的遠期療效;丁苯酞可降低血清PCI患者hs-CRP濃度,有抗炎作用;丁苯酞可增加患者CD34+細胞水平,促進血管新生,有改善側支循環(huán)作用。丁苯酞可改善患者腦血流,增加缺血區(qū)供血。
[Abstract]:Cerebral infarction (Cerebral infarction CI) is a common neurological ischemic cerebrovascular disease, serious harm to people's health is one of the major diseases, especially for progressive cerebral infarction (Progressive cerebral, infarction, PCI) in clinical practice has developed quickly, the fatality rate and disability rate of cerebral infarction was higher than the general characteristics, and it is difficult to predict, treatment it is very difficult, easy to cause the doctor-patient conflicts. Therefore, to explore the method of treatment of progressive cerebral infarction, improve the prognosis of progressive cerebral infarction is one of the important tasks of clinical research. Objective to investigate the progress of butylphthalide on cerebral infarction clinical curative effect and the level of CD34+ cells, the concentration of hs-CRP, the average intracranial blood flow velocity and pulsatility index, to evaluate the therapeutic effect of butylphthalide the progress of cerebral infarction, to provide new ideas for clinical treatment of PCI. Methods according to the National Institutes of Health Stroke Scale (NIHSS) score collection From September 2012 to December 2015 in Jiangsu province hospital neurology department of Huai'an Second People's Hospital in 82 cases of cerebral infarction were randomly divided into two groups, 42 cases in the treatment group, 40 cases in the control group. The control group was given anti platelet aggregation, blood pressure control, the use of statins, regulate blood sugar and improve cerebral circulation therapy, the treatment group on the basis of the control group on butylphthalide 100ml (25mg), 2 times a day, the time limit for the application of continuous application of 14D. through the NIHSS score between the treatment group and the control group improved neurological deficit after two weeks; modified RANKIN (Modified Rankin Scale, MRS) recovery 90 days observation after treatment; Transcranial Doppler (Transcranial Doppler TCD) cerebral artery blood brain detection (Middle cerebral artery, MCA) and posterior cerebral artery (Posterior cerebral artery PCA (Mean Velocity), mean velocity and pulsatility index (Pulse Vm) index , PI), observe the cerebral blood flow and vascular resistance in CD34+ cells by flow cytometry, observe the butylphthalide on intracranial angiogenesis and collateral circulation to improve the situation; by immune latex enhanced turbidimetric method than hs-CRP level detection, determination of butylphthalide on cerebral infarction on blood deficiency caused by control of inflammation. The results of the study; in 1. hospitalized cerebral infarction occurred before the baseline NIHSS score of treatment group was divided into 6.78 + 3.22, 7.07 + 3.93 P0.05 control group, compared two groups, no significant difference; the progress, the NIHSS score of treatment group was 15.53 + 4.47, 15.79 + 4.21 control group, two groups of NIHSS, P0.05, the difference was not statistically significant.2. group of butylphthalide after two weeks of treatment NIHSS score was 7.02 + 2.98; control group two weeks after treatment 10.47 + 2.53. treatment group and control group NIHSS, P0.05, significant difference was statistically significant.3. after two weeks of treatment, the control group cured 2, significantly 鏀瑰杽7渚，

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