【摘要】 目的探究法舒地尔联合尤瑞克林治疗急性脑梗死患者疗效及对血清淀粉样蛋白(serum amyloid A,SAA)、脂蛋白相关磷脂酶A2(Lipoprotein-associated phospholipase A2,Lp-PLA2)与凝血功能的影响。方法以2017年9月至2018年12月就诊的96例急性脑梗死患者为研究对象,按随机数表法分成对照组和试验组,每组48例。患者入院后均接受阿司匹林剂量300 mg, 1次/d,氯吡格雷首次剂量300 mg后75 mg, 1次/d,进行抗血小板治疗。对照组患者采用尤瑞克林0.15PNA滴完,1次/d,共2周。试验组在对照组基础上给予法舒地尔30 mg缓慢静脉滴注,2次/d,共2周。评价2组患者治疗后临床疗效,治疗前及治疗完成后神经功能、脑血流灌注[即大脑中动脉(MCA)、基底动脉(BA)的收缩期峰值血流速度(Vs)、舒张期低值血流流速(Vd)、平均血流速度(Vm)]、血清SAA及Lp-PLA2水平及凝血功能等变化情况,统计2组患者治疗过程中不良反应发生情况。结果治疗后,试验组总有效率明显高于对照组(P<0.05)。治疗后,2组患者神经功能缺损评分明显降低,试验组显著低于对照组(P<0.05)。治疗后,MCA及BA的Vs、Vd、Vm较治疗前明显提高,且试验组明显高于对照组(P<0.05)。治疗后,2组血清SAA及Lp-PLA2水平较治疗前均明显减低,且试验组显著低于对照组(P<0.05)。治疗前,2患者凝血功能指标血小板计数、纤维蛋白原及D-二聚体水平差异无统计学意义(P>0.05),治疗后,2组三项指标明显升高,且试验组显著低于对照组(P<0.05)。2组不良反应发生率差异无统计学意义(P=0.513)。结论法舒地尔联合尤瑞克林治疗急性脑梗死患者临床疗效更好,在恢复神经功能及脑部血流灌注方面具有优势,可降低患者血清SAA、Lp-PLA2水平,降低患者炎性水平,改善患者凝血功能,且不良反应少。更多还原

【Abstract】 Objective To investigate the curative effects of fasudil combined with urinary Kallidinogena on acute cerebral infarction(ACI) and its effects on serum amyloid A(SAA),lipoprotein associated phospholipase A2(Lp PLA2) and coagulation function of patients.Methods A total of 96 patients with ACI who were treated in our hospital from September 2017 to December 2018 were enrolled in the stidy, who were divided into experimental group(n=48) and control group(n=48) according to the random number table.The patients in both groups were treated by aspirin 300 mg once a day and clopidogrel 75 mg once a day, with antiplatelet therapy.The patients in control group were treated by intravenous drip with 0.15 urinary Kallidinogena once a day for 2 weeks, however, the patients in experimental group, on the basis of control group, were treated by intravenous drip with fasudil 30 mg, twice a day for 2 weeks.The clinical curative effects, the changes of nerve function, cerebral blood flow perfusion [systolic peak flow velocity(Vs),diastolic low flow velocity(Vd),mean blood flow velocity(Vm) of the middle cerebral artery(MCA) and the basilar artery(BA)],and the serum levels of SAA,Lp PLA2,coagulation function and adverse reactions were observed and compared between the two groups.Results After treatment the total effective rate in experimental group was significantly higher than that in control group(P<0.05).After treatment, the neurological deficit scores in experimental group were significantly lower than those in control group(P<0.05).After treatment, the Vs, Vd and Vm of MCA and BA in both groups were significantly higher than those before treatment, moreover, which in experimental group were significantly higher than those in control group(P<0.05).After treatment, the levels of SAA and Lp PLA2 in both groups were significantly lower than those before treatment, moreover, which in experimental group were significantly lower than those in control group(P<0.05).Before treatment, there were no significant differences in platelet count, and the levels of fibrinogen and D dimer between the two groups(P>0.05).After treatment, the three indexes in both groups were increased significantly, moreover, which in experimental group were significantly lower than those in control group(P<0.05).Moreover there was no significant difference in adverse reaction between the two groups(P>0.05).Conclusion Fasudil combined with urinary kallidinogenase has better clinical efficacy in treatment of ACI,which has advantages in restoring nervous function and cerebral blood flow perfusion, which can reduce the serum levels of SAA and Lp PLA2 and improve the coagulation function of patients, with little adverse reaction.更多还原