黄芪注射液联合rt-PA治疗急性缺血性脑卒中的临床研究

目的探讨黄芪注射液联合重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对急性缺血性卒中患者的灌注CT检查结果以及脑梗死出血性转化(HT)发生的影响。方法对2013年5月至2014年7月因急性脑缺血性卒中发病6h内入院的54例患者进行回顾性分析,根据不同治疗方法分为rt-PA静脉溶栓治疗组(n=24)和黄芪注射液联合rt-PA组(n=30)两组。收集两组患者部分临床资料,并对所有患者溶栓前及溶栓后24h进行头部CT灌注检查计算出相对脑血流量(rCBF)、脑血容量(rCBV)、脑血管表面通透性(rPS)数值以及根据美国国立卫生研究院卒中量表(NIHSS)计算患者评分,另外收集2周内发生HT的患者例数,最后统计分析两组间治疗前后rCBF、rCBV、rPS、NIHSS评分的差值以及治疗2周内HT发生的病例数有无差别。结果黄芪注射液联合rt-PA组灌注CT参数的rCBF,CBV,rPS以及NIHSS评分治疗前后的差值均高于rt-PA组,差异有统计学意义(P0.05),但两组2周内HT的发生例数差异无统计学意义(P0.05)。结论黄芪注射液联合rt-PA能明显增加急性脑缺血卒中患者的脑部血流情况,同时减轻脑血管表面通透性,进而改善患者预后。

Effect of combination of astragalus injection with recombinant tissue plasminogen activator for the patients with acute ischemic stroke

Objective To observe the effect of combination of astragalus injection with recombinant tissue plasminogen activator (rt‐PA) on the result of CT perfusion and the occurrence of hemorrhagic transformation (HT) in acute ischemic stroke patients . Methods A total of 54 patients with acute ischemic stroke clinically confirmed within 6 h were retrospectively analyzed .According to two different treatment ,54 cases were divided into rt‐PA group (n= 24) and astragalus injection combined with rt‐PA group (n=30) .Partial clinical data ,CT perfusion parameters about relative cerebral blood flow (rCBF) ,relative cerebral blood volume (rCBV) ,relative permeability surface (rPS) and NIHSS scores before and after thrombolytic therapy within 24 h were collected . The number of HT cases occurred in two weeks was also recorded .Then the clinical data ,the baseline NIHSS scores ,the change of the rCBF ,rCBV ,rPS ,NIHSS scores and the incidence rate of HT were compared between the two groups .Results There was no significant difference in clinical data and the base NIHSS scores before the treatment between the two groups (P>0 .05) .After treatment ,the change of rCBF ,rCBV ,rPS and NIHSS scores in astragalus injection combined with rt‐PA group were significantly higher than that of rt‐PA group (P<0 .05) .While there was no difference in the incidence rate of HT between two groups (P>0 .05) .Conclusion Astragalus injection combined with rt‐PA can improve the cerebral blood supply of the patients with acute is‐chemic stroke ,meanwhile it can reduce permeability of cerebral vascular surface ,which consequently improve the prognosis .