银杏二萜内酯葡胺注射液联合依达拉奉右崁醇对急性缺血性脑卒中患者的疗效分析

doi:10.3969/j.issn.1000-8535.2023.06.012

摘要/Abstract

摘要： 目的评价银杏二萜内酯葡胺注射液（DGMI）联合依达拉奉右崁对急性缺血性脑卒中（AIS）的治疗效果。方法回顾性分析我院2021年3月—2022年6月收治的86例AIS患者,根据治疗方法不同,分为单药组和联合组,每组43例,2组均予以DGMI治疗,联合组加用依达拉奉右崁醇。对比2组的治疗效果。结果治疗后,联合组美国国立卫生研究院卒中量表（NIHSS）评分低于单药组（P<0.05）,简易智能精神状态检查量表（MMSE）和Barthel指数（BI）得分高于单药组（P<0.05）;联合组治疗后脑血流动力学指标（Q_min和V_min）高于单药组（P<0.05）,而全血还原黏度、血浆黏度和血小板聚集指数低于单药组（P<0.05）;联合组治疗后血清丙二醛（MDA）、超敏C-反应蛋白（hsCRP）和白细胞介素-6（IL-6）低于单药组（P<0.05）,而超氧化物歧化酶（SOD）高于单药组（P<0.05）;联合组治疗总有效率88.37%,高于单药组的67.44%（P<0.05）,且2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 DGMI联合依达拉奉右崁醇可有效提高AIS患者的神经功能、认知功能及日常生活能力,降低血液高凝状态,改善脑部血流,缓解机体氧化应激及炎症反应,且不良反应发生率较低,安全性良好。

关键词: 急性缺血性脑卒中, 银杏二萜内酯葡胺注射液, 依达拉奉右崁醇, 神经功能, 不良反应

Abstract: Objective To evaluate the clinical efficacy of diterpene ginkgolides meglumine injection（DGMI）combined with edaravone dextracanthol in the treatment of acute ischemic stroke（AIS）．Methods A total of 86 patients with AIS admitted to our hospital from March 2021 to June 2022 were divided into single drug group and combination group according to different treatment methods,with 43 patients in each group．Both groups were treated with DGMI,and the combination group was added with edaravone dextracanthol．The therapeutic effect,neurological function and adverse reactions of the two groups were compared．Results After treatment,compared with the single drug group,the NIH Stroke Scale（NIHSS）score of the combination group was significantly lower（P<0.05）,and the Mini-Mental State Examination（MMSE）and Barthel index（BI）scores were significantly higher（P<0.05）．After treatment,the cerebral hemodynamic indexes（Q_min and V_min）in the combination group were significantly higher（P<0.05）,while the whole blood reducing viscosity,plasma viscosity and platelet aggregation index were significantly lower（P<0.05）．After treatment,compared with the single drug group,the serum malondialdehyde（MDA）,high sensitive C-reactive protein（hsCRP）and interleukin- 6（IL-6）levels in the combination group were significantly lower（P<0.05）,while the level of superoxide dismutase（SOD）was significantly higher（P<0.05）．The total effective rate of the combination group was 88.37%,which was significantly higher than 67.44% of the single drug group（P<0.05）．The incidence of adverse reaction between two groups was not significant（P>0.05）．Conclusions DGMI combined with edaravone dextracanthol can effectively improve the neurological function,cognitive function and daily living ability of patients with AIS,reduce blood hypercoagulability,improve cerebral blood flow,alleviate oxidative stress and inflammatory reaction,improve the therapeutic effect,without increasing the incidence of adverse reactions,which has good safety．

Key words: acute ischemic stroke, diterpene ginkgolides meglumine injection, edaravone dextracanthol, nerve function, adverse reactions

任亚丽, 买雷. 银杏二萜内酯葡胺注射液联合依达拉奉右崁醇对急性缺血性脑卒中患者的疗效分析[J]. 广州医药, 2023, 54(6): 68-73.

REN Yali, MAI Lei. Effect of diterpene ginkgolides meglumine injection combined with edaravone dextracanthol on patients with acute ischemic stroke[J]. Guangzhou Medical Journal, 2023, 54(6): 68-73.

参考文献

[1] 温宏峰,陈宇,王培福.两款脑部医学影像分析软件对急性缺血性脑卒中患者数据处理及结果对比[J].中风与神经疾病杂志,2021,38(6):513-517.
[2] FAIZY T,KABIRI R,CHRISTENSEN S,et al.Venous outflow profiles are linked to cerebral edema formation at noncontrast head CT after treatment in acute ischemic stroke regardless of collateral vessel status at CT angiography[J].Radiology,2021,299(3):682-690.
[3] PSYCHOGIOS K,TSIVGOULIS G.Intravenous thrombolysis for acute ischemic stroke:why not?[J].Curr Opin Neurol,2022,35(1):10-17.
[4] PEDRO K M,ROBERTO K T,CHUA A E.Safety and outcome of decompressive hemicraniectomy after recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke:A systematic review[J].World Neurosurg,2020(144):50-58.
[5] 石叶军,荆玉雷,李超生,等.阿替普酶静脉溶栓后联合替罗非班治疗急性缺血性脑卒中安全性及有效性的Meta分析[J].临床神经病学杂志,2022,35(1):24-29.
[6] 朱晓莉,王宜岭,许海东,等.阿替普酶静脉溶栓治疗急性脑梗死患者的临床效果[J].中国老年学杂志,2020,40(14):2941-2943.
[7] PEDOWITZ E,DERBY L,CRUZ G J,et al.Relationship between NIH stroke symptoms and post-traumatic stress disorder in patients evaluated for transient ischemic attack/stroke[J].Gen Hosp Psychiatry,2021(70):98-102.
[8] AIELLO E N,FIABANE E,MANERA M R,et al.Screening for cognitive sequelae of SARS-CoV-2 infection:a comparison between the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MoCA)[J].Neurol Sci,2022,43(1):81-84.
[9] 周静,王玉龙,刘芳,等.一种新型日常生活活动能力量表与Barthel指数-5项在康复科中应用的特征比较[J].中国康复医学杂志,2021,36(12):1529-1534.
[10] 曾进胜,于生元,谢鹏.重视急性脑梗死后缺血半暗带的临床评估和治疗[J].中国神经精神疾病杂志,2021,47(6):321-323.
[11] YANG S H,LIU R.Four decades of ischemic penumbra and its implication for ischemic stroke[J].Transl Stroke Res,2021,12(6):937-945.
[12] 叶佳蓓,单玉栋,田甜,等.补阳还五汤对缺血性卒中大鼠半暗带脑组织环状RNA表达谱的影响[J].中华中医药杂志,2022,37(5):2525-2530.
[13] 冯红选,桂千,吴冠会,等.银杏二萜内酯葡胺注射液联合阿司匹林治疗大动脉粥样硬化型缺血性脑卒中的临床疗效[J].中国老年学杂志,2020,40(15):3158-3161.
[14] WANG T J,WU Z Y,YANG C H,et al.Multiple mechanistic models reveal the neuroprotective effects of diterpene ginkgolides against astrocyte-mediated demyelination via the PAF-PAFR pathway[J].Am J Chin Med,2022,50(6):1565-1597.
[15] 王倩倩,刘斌,郭娟.依达拉奉右莰醇注射用浓溶液治疗急性脑梗死的疗效与安全性观察[J].中风与神经疾病杂志,2022,39(4):333-335.
[16] 周翔,王炜.依拉达奉结合氯吡格雷对急性脑梗死患者神经功能及脑功能影响[J].中国药物与临床,2019,19(8):1322-1324.
[17] 张颖楠,姜扬,任莉,等.依达拉奉右莰醇静脉滴注对急性前循环脑梗死血管内治疗开通良好患者脑损伤的改善作用[J].山东医药,2021,61(18):76-79.
[18] 赵丰,徐志云.老年急性缺血性脑卒中患者炎症因子,血脂和氧化应激水平的变化[J].中国老年学杂志,2020,40(21):4515-4517.
[19] 刘晓锐. 丁苯酞氯化钠注射液联合rt-PA静脉溶栓治疗47例急性缺血性脑卒中患者的短期临床研究[J].国际医药卫生导报,2019,25(3):404-408.