经颅多普勒超声联合巴曲酶治疗脑梗死急性期的疗效观察

目的:评估在巴曲酶治疗同时应用经颅多普勒超声连续监护照射病变血管是否能够提高巴曲酶对脑梗死急性期的疗效.方法:发病12h内的急性脑梗死患者90例,随机分为对照组(47例)和治疗组(43例),对照组接受巴曲酶10U治疗1次,治疗组患者在巴曲酶治疗的同时应用经颅多普勒超声连续监护照射病变血管1h.监测治疗前及用药后3d的血浆纤维蛋白原,比较2组患者就诊时、巴曲酶治疗后24h、第3日、第5日及1周时的NIHSS评分、进展性卒中及梗死后出血的发生率.结果:2组患者就诊时血浆纤维蛋白原差异无显著性,治疗后第3日治疗组血浆纤维蛋白原低于对照组(P=0.033)；2组患者就诊时、治疗后24h、第3日NIHSS评分差异无显著性,治疗组治疗后第5日及1周时NIHSS评分低于对照组(P=0.030,P =0.002),治疗组进展性卒中的发生率低于对照组(P=0.049),梗死后出血的发生率无显著差异(P=1.000).结论:巴曲酶治疗同时应用经颅多普勒超声对病变血管连续监护照射1h能够增强巴曲酶的降纤作用,提高巴曲酶对脑梗死急性期的疗效.

Observation on therapeutic effect of transcranial Doppler ultrasound combined with Batroxobin in treatment of cerebral infarction at acute phase

Objective:To evaluate the therapeutic effect of continuous transcranial Doppler ultrasound guardianship irradiation at diseased arteries to augment the therapeutic effect of batroxobin-treatment for acute cerebral infarction.Methods:A total of 90 patients with acute cerebral infarction within 12 hours after the onset of symptoms were randomly divided into control group(47 cases) and treatment group(43 cases).All the patients received 10 units of batroxobin-treatment intravenously,simultaneously,patients in treatment group received continuous transcranial doppler ultrasonography guardianship irradiation at diseased arteries for one hour.Plasma fibrinogen was tested before and 3 days after treatment.National Institutes of Health Stroke Scale(NIHSS) score,the incidence of advancing stroke and intracranial hemorrhage after infarction were evaluated before treatment,24 hours,the 3rd,the 5th and the 7th day after batroxobin-treatment.Results:There was no significant difference in plasma fibrinogen between two groups before treatment,plasma fibrinogen was lower at 3rd day after treatment in treatment group than that of control group(P=0.033).NIHSS score was not significantly different in two groups before treatment,24 hours,the 3rd day after batroxobin treatment,while significantly lower in the treatment group at the 5th and the 7th day after batroxobin treatment(P=0.030,P=0.002).The incidence of advancing stroke in the treatment group was significantly lower than that in the control group(P=0.049),the incidences of intracranial hemorrhage after infarction in two groups were not significant different(P=1.000).Conclusions:Application of continuous transcranial Doppler ultrasound monitoring at responsible vessel for one hour can enhance the defibrace-effect of batroxobin and increased the efficacy of batroxobin treatment for acute phase of cerebral infarction.