Abstract:

Objective　To explore the efficacy of cerebrolysin sodium capsules combined with ticlopidine for patients with acute cerebral infarction beyond the thrombolytic time window. Methods　Eighty-one patients with acute ischemic stroke beyond the thrombolytic time window treated at Tongchuan People's Hospital from April 2019 to August 2023 were selected and divided into an observation group (41 patients) and a control group (40 patients) by the random number table method. There were 17 males and 24 females in the observation group; they were (52.23±9.06) years old; their disease course was (37.65±18.77) h; 16 cases had infarction on basal ganglia, 13 cases cerebellum, and 12 cases brainstem; they were treated with citicoline sodium capsules, 1-2 capsules per time, 3 times/d, for 14 d, and dripped tirofiban at 0.4 μg/(kg·min) in the first 30 min and at 0.1 μg/(kg·min) after 30 min for 48 h. There were 21 males and 19 females in the control group; they were (50.68±9.76) years old; their disease course was (38.46±19.20) h; 14 cases had infarction on basal ganglia, 12 cases cerebellum, and 14 cases brainstem; they were treated with tirofiban. The efficacies, cerebral blood flow indicators [peak flow velocity (Vp), mean flow velocity (Vm), and pulsatility index (PI)], platelet parameters [platelet crit (PCT), platelet count (PLT), and mean platelet volume (MPV)], neurological function [evaluated by the National Institutes of Health Stroke Scale (NIHSS)], and daily living ability [evaluated by the Functional Independence Measure (FIM) scale] were compared between the two groups before and after 14 days' treatment. t and χ² tests were used. Results　After 14 days' treatment, the effective treatment rate in the observation group was higher than that in the control group [97.56% (40/41) vs. 82.50% (33/40)], with a statistical difference between the two groups (χ²=4.042, P<0.05). The observation group had higher Vp and Vm and lower PI than the control group [(73.11±8.22) cm/s vs. (64.35±7.19) cm/s, (35.08±3.53) cm/s vs. (32.35±2.97) cm/s, and (0.71±0.12) vs. (0.88±0.13); t=5.100, 3.762, and 6.118; all P<0.05]. The PCT and PLT were higher and the MPV was lower in the observation group than in the control group [(0.35±0.08)% vs. (0.29±0.06)%, (255.08±38.53)×10⁹·L^-1 vs. (225.35±35.97)×10⁹·L^-1, and (8.71±0.92) fl vs. (10.88±1.03) fl; t=3.811, 3.588, and 10.006; all P<0.05]. The NIHSS score was lower and the FIM score was higher in the observation group than in the control group [(3.58±1.17) vs. (4.36±1.21) and (108.11±15.80) vs. (93.58±13.33); t=2.950 and 4.468; both P<0.05]. Conclusion　Cerebrolysin sodium capsules combined with ticlopidine for patients with acute cerebral infarction can improve their cerebral blood flow and platelet parameters, alleviate their neurological deficit symptoms, and enhance their daily living abilities.

Key words:

Acute cerebral infarction, Beyond thrombolysis time window, Cerebrolysin sodium capsules, Ticlopidine, Neurological function

摘要：

目的　探讨胞磷胆碱钠胶囊联合替罗非班治疗超时间窗急性脑梗死的疗效。方法　选取2019年4月至2023年8月期间在铜川市人民医院接受治疗的81例超出治疗时间窗的急性脑梗死患者进行研究，采用随机数字表法分为观察组（41例）和对照组（40例）。观察组男17例、女24例，年龄（52.23±9.06）岁，病程（37.65±18.77）h；梗死部位：基底节16例、小脑13例、脑干12例；采用胞磷胆碱钠胶囊（每天3次，每次1～2粒，治疗14 d）联合替罗非班［滴注起始30 min内，速率为0.4 μg/（kg·min），之后调节为0.1 μg/（kg·min），持续泵入48 h］。对照组男21例、女19例，年龄（50.68±9.76）岁，病程（38.46±19.20）h；梗死部位：基底节14例、小脑12例、脑干14例；仅采用替罗非班（同观察组）治疗。比较两组疗效，治疗前与治疗14 d后的脑血流指标［峰流速（Vp）、平均流速（Vm）、脉动指数（PI）］、血小板参数［血小板压积（PCT）、血小板计数（PLT）、血小板平均容积（MPV）］、神经功能［采用美国国立卫生研究院卒中量表（NIHSS）］和生活自理能力［采用功能独立性评定（FIM）量表］。采用t、χ²检验进行统计分析。结果　治疗14 d后，观察组治疗有效率为97.56%（40/41），高于对照组的82.50%（33/40），两组比较差异有统计学意义（χ²=4.042，P<0.05）；观察组Vp、Vm、PI分别为（73.11±8.22）cm/s、（35.08±3.53）cm/s、（0.71±0.12），对照组分别为（64.35±7.19）cm/s、（32.35±2.97）cm/s、（0.88±0.13），观察组Vp、Vm高于对照组，PI低于对照组（t=5.100、3.762、6.118，均P<0.05）；观察组PCT、PLT、MPV分别为（0.35±0.08）%、（255.08±38.53）×10⁹·L^-1、（8.71±0.92）fl，对照组分别为（0.29±0.06）%、（225.35±35.97）×10⁹·L^-1、（10.88±1.03）fl，观察组PCT、PLT高于对照组，MPV低于对照组（t=3.811、3.588、10.006，均P<0.05）；观察组NIHSS、FIM评分分别为（3.58±1.17）分、（108.11±15.80）分，对照组分别为（4.36±1.21）分、（93.58±13.33）分，观察组NIHSS评分低于对照组，FIM评分高于对照组（t=2.950、4.468，均P<0.05）。结论　胞磷胆碱钠胶囊联合替罗非班治疗能有效改善急性脑梗死患者的脑血流水平和血小板参数，减轻神经缺损症状，提高日常生活能力。

关键词:

急性脑梗死, 超溶栓时间窗, 胞磷胆碱钠胶囊, 替罗非班, 神经功能