摘要
目的:探讨溶栓前使用活血化瘀类中药对急性缺血性脑卒中患者重组组织型纤溶酶原激活剂(rtPA)溶栓疗效的影响。方法:收集2015年7月至2018年12月在上海中医药大学附属曙光医院住院的急性缺血性脑卒中、经rtPA溶栓治疗的患者,共计320例,进行回顾性研究。根据患者溶栓前是否服用活血化瘀类中药将其分为活血化瘀药物组(活血组,188例)和未使用活血化瘀药物组(空白组,132例)。活血组患者又根据其服用活血化瘀药物的种类分为三七类、丹参类、银杏类、补阳还五汤类、心血管类、其他活血通络类、叠加使用类7个亚组。收集所有纳入病例的临床资料,比较两组患者在发病90 d后的改良Rankin量表(mRS)评分中0~1分、2~3分、≥4分的比例,以及两组患者发生溶栓后颅内出血、症状性颅内出血、消化道或泌尿系出血、肺部感染的比例,评价溶栓后活血组中各亚组患者之间的疗效差异。结果:发病90 d后,两组患者的mRS评分比较,差异无统计学意义(P>0.05)。溶栓后,活血组患者症状性颅内出血、肺部感染及消化道与泌尿系出血的发生率较空白组明显降低(P<0.05)。发病90 d后,各亚组患者的mRS评分较溶栓前均明显改善(P<0.05),且三七类组患者的mRS评分改善情况优于其他各亚组(P<0.05)。结论:急性缺血性脑卒中患者进行rtPA溶栓前使用活血化瘀类中药并未增加rtPA溶栓的出血风险,且三七类活血化瘀药物可能对患者神经功能缺损具有较好的改善作用。
Objective:To investigate the influence of promoting-blood and removing-stasis Chinese medicines used before thrombolysis on the efficacy of recombinant tissue plasminogen activator(rtPA)thrombolysis in patients with acute ischemic stroke.Methods:A retrospective study of 320 patients with acute ischemic stroke,who were hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and underwent rtPA thrombolysis from July 2015 to December 2018,was performed.According to the use of promoting-blood and removing-stasis Chinese medicines before thrombolysis,the included patients were divided into the promoting-blood and removing-stasis group(promoting-blood group,188 cases)and the non-promoting-blood and removing-stasis group(blank group,132 cases).The patients in the promoting-blood group were divided into seven subgrouops according to the type of promoting-blood and removing-stasis Chinese medicines,including Notoginseng Radix et Rhizoma group,Salviae Miltiorrhizae Radix et Rhizoma group,Ginkgo biloba group,Buyang Huanwu Decoction group,cardiovascular group,other promoting blood and removing meridians obstruction medicines group,and multi-Chinese medicines group.The clinical data of the included patients were collected,90 days after onset,the ratios of 0-1 point,2-3 point and≥4 point in the modified Rankin scale(mRS)and the incidences of cerebral hemorrhage,symptomatic cerebral hemorrhage,gastrointestinal or urinary hemorrhage,and pulmonary infection after thrombolysis in the two groups were compared,the effects of all subgroups in the promoting-blood group after thrombolysis were evaluated.Results:Ninety days after onset,there was no statistically significant difference on the mRS score between the two groups(P>0.05).After thrombolysis,the incidences of symptomatic cerebral hemorrhage,pulmonary infection and gastrointestinal or urinary hemorrhage in the promoting-blood group were significantly decreased compared with the blank group(P<0.05).Ninety days after onset,the mRS scores of all the subgroups were obviously improved compared with before thrombolysis(P<0.05),and the improvement of mRS score in the Notoginseng Radix et Rhizoma group was superior to the other subgroups(P<0.05).Conclusion:The use of promoting-blood and removing-stasis Chinese medicines before rt PA thrombolysis doesn’t increase the hemorrhage risk of rt PA thrombolysis in patients with acute ischemic stroke,and the promoting-blood and removing-stasis Chinese medicines related to Notoginseng Radix et Rhizoma show better effect on the neurologic function impairment.
作者
龚立
费智敏
王明哲
秦保锋
张红智
龚帆
王骏
潘卫东
GONG Li;FEI Zhimin;WANG Mingzhe;QIN Baofeng;ZHANG Hongzhi;GONG Fan;WANG Jun;PAN Weidong(Department of Neurosurgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Encephalopathy,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《上海中医药大学学报》
CAS
2019年第5期17-21,共5页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
国家自然科学基金面上项目(81373619)
关键词
急性缺血性脑卒中
重组组织型纤溶酶原激活剂
活血化瘀药物
脑卒中单元
acute ischemic stroke
recombinant tissue plasminogen activator
promoting-blood and removing-stasis Chinese medicines
stroke unit
