摘要：
目的 探讨前列地尔联合苦碟子注射液治疗后循环缺血性眩晕的临床疗效及其对溶血磷脂酸(LPA)、酸性磷脂(AP)水平的影响.方法 选取2015年10月至2017年10月宁波大学医学院附属医院收治的后循环缺血患者92例,采用随机数字表法分为观察组和对照组各46例.对照组采用苦碟子注射液治疗,观察组采用前列地尔联合苦碟子注射液治疗,比较两组的临床疗效及治疗前后LPA、AP水平变化.结果 治疗后,观察组总有效率为95.65％,对照组总有效率为82.61％,差异有统计学意义(x2=8.622,P＜0.05).治疗后,两组双侧椎-基底动脉平均血流速度(Vm)、收缩期峰流速(Vs)较治疗前均明显增快(观察组:t=14.041、11.124、11.207、10.057、10.925、11.920;对照组:t=7.204、7.057、8.145、6.572、6.581、5.481;均P＜0.05);与对照组比较,观察组双侧椎-基底动脉Vm[(34.24±3.04) cm/s、(30.54±3.33) cm/s、(35.42±3.46) cm/s]、Vs[(40.09 ±5.14)cm/s、(40.24±5.02) cm/s、(43.14 ±4.97) cm/s]均显著增高,差异均有统计学意义(t=7.825、4.581、8.610、7.256、7.017、5.824,均P＜0.05).治疗后,两组患者LPA、AP水平较治疗前均显著降低(观察组:t=18.054、17.259;对照组:t=17.651、14.254;均P＜0.05);与对照组LPA[(1.75±0.52) μmol/L]、AP[(2.42 ±0.51) μmol/L]水平比较,观察组患者LPA[(1.05±0.28) μmol/L]、AP[(1.84±0.48) μmol/L]水平均显著降低,差异均有统计学意义(t=8.571、7.224,均P＜0.05).两组患者治疗前白细胞计数分别为(6.23±0.54)×109/L、(6.68±0.57)×109/L;治疗后白细胞计数分别为(6.57±0.61)×109/L、(6.42±0.64)× 109/L,差异均无统计学意义(均P＞0.05).治疗过程中,两组均未出现明显不良反应.结论 前列地尔联合苦碟子注射液治疗后循环缺血性眩晕临床疗效显著,LPA、AP水平明显改善,未发生白细胞减少等不良反应,安全性较好.%Objective To explore the clinical effect of alprostadil combined with Kudiezi injection in the treatment of posterior circulation ischemic vertigo,and its effect on levels of lysophosphatidic acid (LPA),acidic phospholipid (AP).Methods From October 2015 to October 2017,92 cases of posterior circulation ischemia in the Affiliated Hospital of Medical College were selected and randomly divided into observation group(n =46) and control group(n =46) according to the digital table.The control group was treated with Kudiezi injection,while the observation group was treated with alprostadil combined with Kudianzi injection.The clinical efficacy and LPA,AP levels before and after treatment were compared between the two groups.Results After treatment,the total effective rate in the observation group was 95.65％,which in the control group was 82.61％,there was statistically significant difference between the two groups(x2 =8.622,P ＜0.05).After treatment,Vm and Vs of bilateral vertebrobasilar artery in both two groups were increased more rapidly than those before treatment(observation group:t =14.041,11.124,11.207,10.057,10.925,11.920;control group:t =7.204,7.057,8.145,6.572,6.581,5.481,all P ＜ 0.05).Compared with the control group,the Vm [(34.24 ± 3.04) cm/s,(30.54 ± 3.33) cm/s,(35.42 ± 3.46) cm/s] and Vs[(40.09 ± 5.14) cm/s,(40.24 ± 5.02) cm/s,(43.14 ± 4.97) cm/s] of bilateral vertebrobasilar artery in the observation group were significantly higher (t =7.825,4.581,8.610,7.256,7.017,5.824,all P ＜ 0.05).After treatment,the levels of LPA and AP in the two groups were significantly lower than those before treatment(observation group:t =18.054,17.259;control group:t =17.651,14.254,all P ＜ 0.05).The levels of LPA and AP in the control group [(1.75 ± 0.52) μmol/L,(2.42 ± 0.51) μmol/L] were significantly higher than those in the observation group [[(1.05 ± 0.28) μmol/L,(1.84 ± 0.48) μmol/L] (t =8.571,7.224,all P ＜ 0.05).Before treatment,the number of white blood cells in two groups were (6.23 ±0.54) × 109/L,(6.68 ±0.57) × 109/L,respectively,which after treatment were (6.57 ±0.61) × 109/L,(6.42 ±0.64) × 109/L,respectively,there was no statistically significant difference in leukocyte count between the two groups before and after treatment(all P ＜ 0.05).During the treatment,there was no obvious adverse reaction in the two groups.Conclusion Alprostadil combined with Kudiezi injection in the treatment of circulatory ischemic vertigo has excellent clinical effect,there are no adverse reactions such as leukopenia occurred and the safety is good.
