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目的:观察经颅多普勒超声辅助动脉溶栓联合活血化瘀汤治疗急性脑梗死的临床疗效,优化临床治疗效果。方法:选取医院收治的80例急性脑梗死患者作为观察对象,采用SPSS 19.0生成随机数字表,按入院顺序随机分为研究组40例和对照组40例,对照组给予重组人组织型纤溶酶原激活剂(rt-PA)动脉溶栓,并给予经颅多普勒超声(TCD)辅助溶栓,术后给予双重抗血小板聚集、扩容、改善血液循环及神经保护等常规西药治疗,观察组在对照组的基础上,术后再口服活血化瘀汤,连续服用14 d,治疗前、治疗后7 d、治疗后14 d进行神经功能缺损评分(NIHSS评分)及日常生活活动能力量表(Barthel指数)评分,治疗前后进行血液流变学指标[血细胞比容(HCT)、全血高切黏度(HWBV)、全血低切黏度(LWBV)、血浆黏度(PV)、纤维蛋白原(FIB)]、炎症因子[白介素-6(IL-6)、超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子-a(TNF-a)]及血浆和肽素(copeptin)检测,比较两组临床疗效。结果:研究组和对照组治疗后7 d、治疗后14d的NIHSS评分均明显下降(均P<0.05),Barthel指数均明显升高(均P<0.05),但研究组NIHSS评分下降更明显(均P<0.05),Barthel指数升高更明显(均P<0.05)。研究组治疗后HCT、HWBV、LWBV、PV、FIB均明显下降(均P<0.05),对照组仅HWBV、LWBV、PV明显下降(均P<0.05),且研究组HCT、HWBV、LWBV、FIB下降更明显(均P<0.05)。两组治疗后IL-6、hs-CRP、TNF-a、copeptin均明显下降,但研究组IL-6、hs-CRP、TNF-a、copeptin下降更明显(P均<0.05)。研究组的临床总有效率为92.5%,对照组为77.5%,差异具有统计学意义(χ~2=11.652,P<0.05)。结论:经颅多普勒超声辅助动脉溶栓后再联合活血化瘀汤可优化临床治疗效果,有效降低炎性因子水平及和肽素水平,改善血液流变学,恢复对病灶脑组织的供血供氧,促进神经功能缺损恢复及日常生活能力改善,提高了患者生活质量。
Objective: To observe the clinical effect of transcranial Doppler ultrasound assisted thrombolysis combined with activating blood and resolving stasis in treating acute cerebral infarction, and optimize the effect of clinical treatment. Methods: Eighty patients with acute cerebral infarction admitted to our hospital were selected as observation objects. The random number table was generated by SPSS 19.0. According to the order of hospital admission, 40 patients were randomly divided into study group (40 cases) and control group (40 cases). The control group was given recombinant human tissue plasminogen (Rt-PA) arterial thrombolysis, and given transcranial Doppler ultrasound (TCD) assisted thrombolysis, postoperative dual anti-platelet aggregation, expansion, to improve blood circulation and neuroprotection and other conventional Western medicine treatment group, the observation group On the basis of the control group, the rats were treated with Huoxuehuayu decoction orally for 14 days, before and after treatment for 7 days and 14 days after treatment. The NIHSS score and daily living activity scale (Barthel index), hemorheology index (hematocrit (HWT), HWBV, LWBV, PV, FIB ), Inflammatory cytokines (IL-6, hs-CRP, TNF-a) and plasma and copeptin Group clinical efficacy. Results: On the 7th day after treatment, the NIHSS scores of the study group and the control group decreased significantly (all P <0.05) and Barthel index (all P <0.05) on the 14th day after treatment, but the NIHSS scores decreased more significantly in the study group All P <0.05), Barthel index increased more significantly (all P <0.05). The levels of HCT, HWBV, LWBV, FIB and FIB in the study group were significantly decreased (all P <0.05), and only HWBV, LWBV and PV in the control group were significantly decreased (all P <0.05) Decreased more significantly (all P <0.05). The levels of IL-6, hs-CRP, TNF-a and copeptin in both groups were significantly decreased after treatment, but the decrease of IL-6, hs-CRP, TNF-a and copeptin in the study group was more obvious (all P <0.05). The total clinical effective rate was 92.5% in the study group and 77.5% in the control group, with statistical significance (χ ~ 2 = 11.652, P <0.05). Conclusion: Transcranial Doppler ultrasound-assisted thrombolysis combined with Huoxuehuayu decoction can optimize the clinical therapeutic effect, effectively reduce the levels of inflammatory cytokines and copeptin, improve hemorheology, and restore blood supply to the brain tissue of the lesion Oxygen, to promote the recovery of neurological deficits and improvement of daily living ability, improve the quality of life of patients.