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目的观察依达拉奉联合血栓通治疗老年性脑梗死患者的临床疗效及安全性。方法将78例脑梗死患者随机分为对照组39例和试验组39例。对照组予以静脉滴注血栓通冻干粉针200 mg qd+静脉滴注胞磷胆碱钠0.25 g qd;试验组予以静脉滴注血栓通冻干粉针200 mg qd+静脉滴注依达拉奉30 mg bid。2组患者均治疗14 d。比较2组患者的临床疗效、治疗前和治疗后缺氧诱导因子-1(HIF-1)、半胱氨酸蛋白酶-3(Caspase-3)、肿瘤坏死因子-α(TNF-α)、血流动力学、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为87.18%(34/39例)和74.36%(29/39例),差异无统计学意义(P>0.05)。治疗后,试验组和对照组的血清HIF-1分别为(713.63±115.72),(924.68±118.92)ng·m L~(-1);Caspase-3分别为(11.02±1.62),(12.08±1.68)ng·m L~(-1);TNF-α分别为(8.26±1.19),(11.53±1.78)pg·m L~(-1);全血高切黏度分别为(4.26±0.61),(4.63±0.65)m Pa·s-1;全血低切黏度分别为(11.38±1.72),(12.78±1.64)m Pa·s-1;血浆黏度分别为(1.23±0.18),(1.46±0.21)m Pa·s-1;纤维蛋白原分别为(2.72±0.33),(3.05±0.36)g·L~(-1);NIHSS评分分别为(7.36±1.08),(9.63±1.49)分;Barthel指数分别为(59.32±8.53),(51.78±7.34)分,差异均有统计学意义(P<0.05)。2组患者的药物不良反应以胃肠道反应和皮疹为主,且试验组和对照组的药物不良反应发生率分别为7.69%和10.26%,差异无统计学意义(P>0.05)。结论与胞磷胆碱钠联合血栓通相比,依达拉奉联合血栓通治疗老年性脑梗死的临床疗效和安全性相当,但后者能显著降低老年性脑梗死患者的血清HIF-1、Caspase-3、TNF-α水平,改善血流动力学。
Objective To observe the clinical efficacy and safety of edaravone combined with Xueshuantong in the treatment of senile cerebral infarction. Methods 78 patients with cerebral infarction were randomly divided into control group 39 cases and test group 39 cases. The control group was given intravenous infusion of thrombosis freeze-dried powder 200 mg qd + intravenous citicoline 0.25 g qd; experimental group was given intravenous infusion of thrombosis freeze-dried powder 200 mg qd + intravenous infusion of edaravone 30 mg bid. Two groups of patients were treated for 14 days. The clinical efficacy of HIF-1, Caspase-3, TNF-α and blood before and after treatment were compared between the two groups. Flow dynamics, NIH Stroke Scale (NIHSS) score, Barthel Index, and adverse drug reactions. Results After treatment, the total effective rates of the experimental group and the control group were 87.18% (34/39 cases) and 74.36% (29/39 cases), respectively, with no significant difference (P> 0.05). After treatment, the serum HIF-1 levels of the experimental group and the control group were (713.63 ± 115.72) and (924.68 ± 118.92) ng · m L -1, respectively, and those of Caspase-3 were 11.02 ± 1.62 and 12.08 ± 1.68) ng · m L -1 and TNF-α were (8.26 ± 1.19) and (11.53 ± 1.78) pg · m L -1, respectively. The whole blood high shear viscosity was (4.26 ± 0.61) , (4.63 ± 0.65) mPa · s-1, respectively. The whole blood low shear viscosity was (11.38 ± 1.72) and (12.78 ± 1.64) mPa · s-1 respectively.The plasma viscosities were (1.23 ± 0.18) and ± 0.21) m Pa · s-1, respectively. The levels of fibrinogen were (2.72 ± 0.33) and (3.05 ± 0.36) g · L -1, NIHSS scores were (7.36 ± 1.08) and (9.63 ± 1.49) Points; Barthel index was (59.32 ± 8.53), (51.78 ± 7.34) points, the difference was statistically significant (P <0.05). Adverse drug reactions in the two groups were mainly gastrointestinal reactions and rashes, and the adverse drug reactions in the two groups were 7.69% and 10.26% respectively, with no significant difference (P> 0.05). Conclusion Compared with citicoline sodium combined with Xueshuantong, Edaravone combined Xueshuantong treatment of senile cerebral infarction clinical efficacy and safety, but the latter can significantly reduce the elderly patients with cerebral infarction serum HIF-1, Caspase-3, TNF-α levels, improve hemodynamics.