發(fā)布時間：2018-07-06 08:21

  本文選題：慢性腦供血不足 + 丁苯酞　； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的利用動脈質(zhì)子自旋標記(Arteiral spin labeling,ASL)灌注成像技術(shù)觀察丁苯酞聯(lián)合尤瑞克林治療慢性腦供血不足(Chronic cerebral circulatory insufficiency,CCCI)的臨床效果,期望為CCCI的臨床治療提供依據(jù)。方法選取2015年10月-2016年10月就診于河北省唐山工人醫(yī)院神經(jīng)內(nèi)科并確診為CCCI的患者,將符合入組標準的研究對象采用信封抽簽方式隨機分為3組,聯(lián)合治療組因選擇支架植入術(shù)脫落2例,最終收錄丁苯酞組25例,尤瑞克林組25例,聯(lián)合治療組有23例。參照2014版中國缺血性腦卒中和短暫性腦缺血發(fā)作二級預(yù)防指南,給予三組研究對象相應(yīng)支持和防治并發(fā)癥、活血化瘀等常規(guī)治療,丁苯酞組在給予常規(guī)治療的基礎(chǔ)上加用丁苯酞氯化鈉注射液100ml靜點,每日1次,連續(xù)給藥14天;尤瑞克林組在常規(guī)治療的基礎(chǔ)上給予尤瑞克林0.15 PNAU(pnitroaniline單位),將其混于100ml 0.9%的氯化鈉注射液中,靜脈滴注30分鐘,一日1次,連續(xù)使用14天;聯(lián)合治療組在常規(guī)治療的基礎(chǔ)上同時給予丁苯酞注射液100ml及尤瑞克林注射液0.15 PNAU靜點治療,療程同樣為14天�；颊哂谥委熐昂笮写殴舱馎SL檢查,觀察治療前后患者的患側(cè)腦血流量(Cerebral blood flow,CBF)、健側(cè)CBF值及相對腦血流量值(Relative cerebral blood flow,r CBF)的變化,r CBF=患側(cè)CBF/健側(cè)CBF,進而評價丁苯酞聯(lián)合尤瑞克林治療CCCI的臨床療效。結(jié)果1基線資料比較:三組患者的年齡、性別及危險因素(包括吸煙史、高脂血癥、高血壓、糖尿病及心臟病)進行比較,差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。2 ASL腦血流量結(jié)果:三組患者治療后患側(cè)CBF、r CBF值均高于治療前(P0.05),治療前后的變化有統(tǒng)計學(xué)意義;治療前后健側(cè)CBF值的變化無顯著差異(P0.05)。治療前后,聯(lián)合治療組的患側(cè)CBF、r CBF值的增加均高于另外兩組,且比較有統(tǒng)計學(xué)意義(P0.05)。3臨床效果比較:聯(lián)合治療組總有效率87%,高于丁苯酞組(71%)和尤瑞克林組(68%)(P0.05)。4尤瑞克林組出現(xiàn)1件不良事件,聯(lián)合治療組1例,丁苯酞組未出現(xiàn)不良事件。不良事件只有2例,無統(tǒng)計學(xué)意義。丁苯酞與尤瑞克林臨床上聯(lián)合應(yīng)用安全可靠,可放心使用。結(jié)論1利用ASL技術(shù)可以觀察丁苯酞聯(lián)合尤瑞克林改善CCCI低灌注情況;2丁苯酞與尤瑞克林聯(lián)合應(yīng)用治療方案對于改善CCCI患者低灌注、增加局部腦血流量及改善患者臨床癥狀等方面作用顯著,優(yōu)于兩種單獨應(yīng)用。3丁苯酞與尤瑞克林聯(lián)合應(yīng)用過程中無明顯不良反應(yīng)及毒副作用,可以安全應(yīng)用。
[Abstract]:Objective to observe the clinical effect of butyphthalide combined with eucrine in the treatment of chronic cerebral circulatory insufficiency by using proton spin-labeled (Arteiral spin labelingus perfusion imaging technique, and to provide evidence for clinical treatment of chronic cerebral circulatory insufficiency. Methods the patients who were diagnosed as CCCI in Department of Neurology, Tangshan Workers Hospital, Hebei Province from October 2015 to October 2016 were randomly divided into 3 groups by drawing lots in envelopes. In the combined treatment group, 2 cases were lost because of selective stent implantation, 25 cases in the butyrophthalide group, 25 cases in the eucrine group and 23 cases in the combined treatment group. Referring to the 2014 edition of China's secondary guidelines for the prevention of ischemic stroke and transient ischemic attack, three groups of subjects were given corresponding support, prevention and treatment of complications, and routine treatment of promoting blood circulation and removing blood stasis. In butyphthalide group, 100ml was added to the routine therapy, once a day for 14 days. On the basis of routine therapy, Urethrin group was given Urethrin 0.15 PNAU (pnitroaniline unit), mixed with 0.9% of 100ml sodium chloride injection, intravenous drip for 30 minutes, once a day, continuously used for 14 days. The combined group was treated with butyphthalide injection (100ml) and eurexacin injection (0.15 PNAU) on the basis of routine treatment. The course of treatment was 14 days. The patients underwent Mr ASL before and after treatment. The changes of cerebral blood flow (CBF), relative cerebral blood flowrate (CBF) and relative cerebral blood flowrate (CBF) were observed before and after treatment. The clinical efficacy of butyphthalide combined with eurekline in the treatment of CCCI was evaluated. Results 1 comparison of baseline data: age, sex and risk factors (including smoking history, hyperlipidemia, hypertension, diabetes and heart disease) were compared among the three groups. There was no significant difference (P0.05), there was no significant difference in CBF before and after treatment (P0.05), and there was no significant difference in CBF before and after treatment (P0.05). Before and after treatment, the CBF of the affected side in the combined treatment group was higher than that in the other two groups. The total effective rate of the combined treatment group was 87, which was higher than that of the butylphthalide group (71%) and the eurexacin group (68%) (P0.05). The adverse events in the combined treatment group (1 case) were higher than those in the butyphthalide group (68%) (P0.05), while in the combined treatment group (1 case), there were no adverse events in the butylphthalide group. There were only 2 cases of adverse events with no statistical significance. The combination of butyphthalide and eurekline is safe and reliable in clinical use. Conclusion (1) by using ASL technique, it can be observed that butyphthalide combined with Urethrin can improve the low perfusion of CCCI patients and that the combination of butyrophthalide and Urethrin can improve the low perfusion of CCCI patients. The effects of increasing the local cerebral blood flow and improving the clinical symptoms of the patients were significant, which were superior to those of the two groups in combination of butyrophthalide and eurexacin. There were no obvious adverse reactions and side effects during the treatment, so they could be safely used.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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