早期丁苯酞联合尿激酶静脉溶栓对不同CISS分型急性脑梗死的近期疗效评价

林惠贤 文学 岑雄图 梁献升 黄光位

【摘要】 目的：探讨早期丁苯酞联合尿激酶静脉溶栓对不同CISS分型急性脑梗死的近期疗效。方法：选取2017年4月-2019年4月笔者所在医院收治的急性脑梗死患者102例，CISS分型为大动脉粥样硬化型（LAA）45例，心源性卒中型（CS）19例，穿支动脉疾病型（PAD）38例。所有病例在发病6 h内予尿激酶静脉溶栓治疗，并早期联合丁苯酞治疗。治疗30 d后比较CISS分型各亚型临床疗效，以及治疗前后NIHSS评分、ADL评分和hs-CRP水平变化。结果：LAA治疗总有效率高于PAD及CS，且PAD治疗总有效率高于CS，差异均有统计学意义（P<0.05）。治疗期间各组均未出现出血转化、再发脑梗死等严重并发症;未出现严重药物不良反应。治疗前，CISS分型各亚型NIHSS評分、ADL评分、hs-CRP水平比较差异无统计学意义（P>0.05）;治疗后，CISS分型各亚型NIHSS评分均低于治疗前，ADL评分均高于治疗前，hs-CRP水平均低于治疗前，治疗后LAA各指标均优于PAD及CS，PAD优于CS，差异均有统计学意义（P<0.05）。结论：早期丁苯酞联合尿激酶静脉溶栓治疗对不同CISS分型急性脑梗死具有较好疗效，尤其是LAA和PAD亚型，能够促进脑梗死患者神经功能的恢复，提高日常生活能力，减轻炎症反应，临床上值得推广使用。

【关键词】 丁苯酞 尿激酶 急性脑梗死 CISS分型

doi：10.14033/j.cnki.cfmr.2020.20.002 文献标识码 A 文章编号 1674-6805（2020）20-000-03

Evaluation of Short-term Efficacy of Early Butylphthalide Combined with Intravenous Thrombolysis with Urokinase on Acute Cerebral Infarction of Different CISS Types/LIN Huixian， WEN Xue， CEN Xiongtu， LIANG Xiansheng， HUANG Guangwei. //Chinese and Foreign Medical Research， 2020， 18（20）： -7

[Abstract] Objective： To investigate the short-term effect of early Butylphthalide combined with intravenous thrombolysis with Urokinase on acute cerebral infarction of different CISS types. Method： A total of 102 patients with acute cerebral infarction from April 2017 to April 2019 were selected. The CISS classification included 45 patients with large artery atherosclerosis （LAA）， 19 patients with cardioembolic stroke （CS）， and 38 patients with perforating artery disease （PAD）. All cases were treated with intravenous thrombolysis with urokinase within 6 hours of onset， and combined with early Butylphthalide therapy. After 30 days of treatment， the clinical efficacy of each subtype of CISS classification was compared， as well as the changes of NIHSS score， ADL score and hs-CRP level before and after treatment. Result： The total effective rate of LAA was higher than that of PAD and CS， and the total effective rate of PAD was higher than that of CS， the differences were statistically significant （P<0.05）. No serious complications such as bleeding transformation and recurrent cerebral infarction occurred in each group during treatment.No serious adverse drug reactions occurred.Before treatment， there were no statistically significant differences in NIHSS score， ADL score and hs-CRP level among the CISS subtypes （P>0.05）. After treatment， the NIHSS scores of all subtypes of CISS classification were lower than those before treatment， the ADL scores were higher than those before treatment， hs-CRP levels were lower than those before treatment， and all indexes of LAA were better than those of PAD and CS after treatment， the indexes of PAD were better than those of CS， the differences were statistically significant （P<0.05）. Conclusion： Early Butylphthalide combined with intravenous thrombolysis with Urokinase has a good effect on acute cerebral infarction of different CISS types， especially LAA and PAD subtypes， which can promote the recovery of neurological function in patients with cerebral infarction， improve daily living ability， and reduce inflammatory reaction， which is worthy of clinical promotion.

[Key words] Butylphthalide Urokinase Acute cerebral infarction CISS types

First-authors address： Yangjiang Peoples Hospital， Yangjiang 529500， China

急性脑梗死具有较高的发病率和病死率，严重影响人类的健康，同时，由于其病因多样，发病机制复杂，使临床治疗难度增加，影响治疗效果，因此，如何针对病因采取有效的治疗方案成为当前治疗急性脑梗死的研究新方向。中国缺血性卒中亚型分型（CISS）从经典TOAST分型改良而成，是基于脑卒中病因和发病机制的新的分型方法，已成为当前急性脑梗死对因治疗的有力武器。目前治疗脑梗死效果最明确的方法是静脉溶栓，其中尿激酶是临床常用的溶栓药物。丁苯酞作为新一代的脑血管类药物[1]，能够有效改善脑微循环，保护神经细胞[2]，调节炎症反应，疗效好且安全性高[3]。本研究选取笔者所在医院收治的不同CISS分型急性脑梗死患者予早期使用丁苯酞联合尿激酶静脉溶栓治疗，探讨不同亚型的近期治疗效果，现报道如下。……