脑血管反应性与尤瑞克林治疗急性脑梗死预后的相关性：随机单盲对照研究

摘要

Objective To investigate the correlation between cerebrovascular reactivity and the prognosis of patients with acute cerebral infarction treated by urinarykallid. Methods In this randomized,single - blind and control study,we enrolled 194 patients with acute cerebral infarction in arterial blood supply area of right brain who were admitted into the Department of Neurology of the First Affiliated Hospital of He'nan University of Science and Technology from December 2011 to May 2014. Breath - holding index( HBI)of the middle cerebral artery( MCA)in the brain hemisphere with infarction was measured using transcranial doppler sonography( TCD)and breath - holding test. Treatment group( n = 89 ) was given conventional therapy combined with urinarykallid for 15 days,and control group(n = 105)was given conventional treatment for 15 days. Before treatment and 16 days after treatment,we recorded NIHSS and mRS scores of the two groups,and the correlation between HBI and the scores was analyzed. Results The two groups had lower(P ﹤ 0. 05)scores of NIHSS and mRS on 16 days after treatment than before treatment;16 days after treatment,the two groups were significantly different(P ﹤ 0. 05) in the scores of NIHSS and mRS scores. The correlation analysis showed that,on 16 days during treatment,HBI was positively correlated with reduction of NIHSS and mRS scores in treatment group(r = 0. 427,0. 620,P ﹤ 0. 001);on 16 days during treatment,HBI was positively correlated with reduction of NIHSS scores in control group(r = 0. 618,P ﹤ 0. 001),and HBI had no linear correlation with reduction of mRS scores(r = 0. 191,P ﹥ 0. 05). Conclusion For patients with acute cerebral infarction,there is positive correlation between the vascular reactivity evaluated by TCD and short - term prognosis of patients treated by urinarykallid.%目的：探讨脑血管反应性与尤瑞克林治疗急性脑梗死预后的相关性。方法采用随机、单盲、对照试验，选择河南科技大学第一附属医院神经内科2011年12月—2014年5月收治的194例右侧大脑中动脉供血区急性脑梗死患者，利用经颅多普勒超声（TCD）结合屏气试验检测梗死同侧大脑中动脉（MCA）的屏气指数（HBI），治疗组（89例）给予常规治疗＋尤瑞克林治疗15 d，对照组（105例）给予常规治疗15 d。治疗前和治疗第16天，评估记录两组患者的美国国立卫生研究院脑卒中量表（NIHSS）评分和改良残疾程度量表（mRS）评分，分析 HBI 与 NIHSS 评分及 mRS 评分降幅的相关性。结果与治疗前比较，治疗第16天对照组和治疗组 NIHSS 评分与 mRS 评分均下降，差异有统计学意义（P ﹤0.05）；治疗第16天时，对照组和治疗组 NIHSS 评分、mRS 评分比较，差异均有统计学意义（P﹤0.05）。相关性分析显示，治疗第16天时，治疗组 HBI 与 NIHSS 评分降幅、mRS 评分降幅均呈正相关（r ＝0.427、0.620，P ﹤0.001）。治疗第16天时，对照组 HBI 与 NIHSS 评分降幅呈正相关（r ＝0.618，P ﹤0.001）；对照组 HBI 与mRS 评分降幅无直线相关性（r ＝0.191，P ﹥0.05）。结论对于急性脑梗死患者，TCD 评价下的脑血管反应性与尤瑞克林治疗急性脑梗死的短期预后呈正相关。