亚低温联合丁基苯酞对溶栓时间窗外急性大脑中动脉闭塞患者预后的影响

摘要

目的 探讨亚低温(mild hypothermia,MHT)联合丁基苯酞(dl-3n-butyphthalide,NBP)对溶栓时间窗外急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)且出现进展性运动功能缺损(progressive motor deficit,PMD)患者的脑侧支循环和短期预后的影响.方法 纳入溶栓时间窗外且合并PMD的急性MCAO患者,随机分为常规治疗组、MHT组和MHT+NBP组.比较3组患者入院时基线资料、治疗14 d时Fugl-Meyer运动功能评分、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、出血性转化以及经颅多普勒超声检测的脑侧支循环通路开放情况、患侧与健侧大脑前动脉(anterior cerebral artery,ACA)收缩期峰值流速比值(RVaca)和大脑后动脉(posterior cerebral artery,PCA)收缩期峰值流速比值(RVpca);治疗90 d时改良Rankin量表(modified Rankin scale,mRS)评分、90 d死亡率.结果 入组本研究且完成随访的患者共69例,其中常规治疗组23例,MHT组21例,MHT+NBP组25例.MHT+NBP组14 d Fugl-Meyer运动功能评分、前交通动脉通路开放、后交通动脉通路开放、RVaca及RVpca均高于MHT组和常规治疗组,差异有统计学意义(均P<0.05).MHT+NBP组14 d NIHSS评分、90 d mRS评分低于MHT组和常规治疗组,差异有统计学意义(均P<0.05).MHT+NBP组14 d出血性转化低于常规治疗组(P<0.05).MHT组14 d RVaca、RVpca及90 d mRS评分低于常规治疗组(均P<0.05).3组90 d死亡率的差异无统计学意义.结论 MHT联合NBP治疗可以改善溶栓时间窗外急性MCAO且出现PMD患者的脑侧支循环,并改善患者的短期预后.%Objective To investigate the effect of mild hypothermia (MHT) combined with dl-3n-butyphthalide (NBP) on collateral circulation and short-term prognosis of patients with acute middle cerebral artery occlusion (MCAO) and progressive motor deficit (PMD) beyond thrombolysis time. Methods Patients with acute MCAO and PMD beyond thrombolysis time were recruited consecutively. They were randomized into the conventional treatment group, the MHT group and the MHT+NBP group. The parameters between the three groups, including baseline clinical data, the Fugl-Meyer motor function scores at Day 14, collateral circulation, the National Institute of Health Stroke Scale (NIHSS) scores, the hemorrhagic transformation, the anterior communicating artery (ACoA), the posterior communicating artery (PCoA), the ipsilateral and contralateral systolic peak flow velocity ratio of anterior cerebral artery (RVaca) and posterior cerebral artery (RVpca), the modified Rankin scale (mRS) scores at Day 90, the rate of mortality at Day 90, were compared. Results A total of 69 patients having completed follow-up were recruited in the study, including 23 in the conventional treatment group, 21 in the MHT group, and 25 in the MHT+NBP group. The Fugl-Meyer motor function scores at Day 14, the anterior communicating artery (ACoA), the posterior communicating artery (PCoA), RVaca, RVpca in the MHT+NBP group were respectively higher than that in the MHT group and conventional treatment group (all P<0.05). The NIHSS scores at Day 14, the mRS scores at Day 90 in the MHT+NBP group were respectively lower than that in the MHT group and CT group (all P<0.05). The hemorrhagic transformation at Day 14 in the MHT+NBP group was lower than in the conventional treatment group (P<0.05). The RVaca at Day 14, and the mRS scores at Day 90 in the MHT group were lower than that in the conventional treatment group (all P<0.05). There were no significant difference in 90-day mortality rate among the three groups. Conclusion MHT combined with NBP could improve collateral circulation and short-term prognosis in patients with acute MCAO and PMD beyond thrombolysis time.