作者：张金才，孙照芬，史福俊

单位：

230031安徽省合肥市，中国人民解放军联勤保障部队第九〇一医院院前急救科

Units：

Prehospital First Aid, the 901st Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Hefei 230031, China

关键词：

脑梗死；天麻素注射液；尼莫地平；治疗结果；炎症因子；血管内皮因子

Keywords：

Brain infarction; Tian Ma Su Zhu She Ye; Nimodipine; Treatment outcome; Inflammatory factors; Vascular endothelial factors

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2024.00.034

Funds：

安徽省自然科学基金资助项目（1908085MH262）

摘要：

目的　探讨天麻素注射液联合尼莫地平治疗急性脑梗死的临床疗效及其对患者炎症因子、血管内皮因 子的影响。方法　本研究为单盲、随机对照试验。选取2019年3月—2022年2月中国人民解放军联勤保障部队第九〇一 医院收治的急性脑梗死患者92例，采用随机数字表法将其分为联合治疗组（ n=46）与尼莫地平组（n=46）。给予两 组抗凝、抗血小板聚集及控制血脂、血糖、血压等基础治疗，尼莫地平组在此基础上给予尼莫地平口服，联合治疗 组在尼莫地平组的基础上给予天麻素注射液静脉滴注，两组治疗时间均为14 d。比较两组临床疗效，治疗前后日常生 活活动能力（采用Barthel指数评估）、神经功能〔采用美国国立卫生研究院卒中量表（NIHSS）评分评估〕、炎症因 子〔肿瘤坏死因子α（TNF-α）、白介素8（IL-8）〕、血管内皮因子〔一氧化氮（NO）、内皮素1（ET-1）〕及治 疗期间不良反应发生情况。结果　治疗后，联合治疗组临床疗效优于尼莫地平组（P＜0.05）。治疗后，两组Barthel指 数分别高于同组治疗前，NIHSS评分分别低于同组治疗前，联合治疗组Barthel指数高于尼莫地平组，NIHSS评分低于 尼莫地平组（P＜0.05）。治疗后，两组TNF-α、IL-8分别低于同组治疗前，联合治疗组TNF-α、IL-8低于尼莫地平 组（P＜0.05）。治疗后，两组NO分别高于同组治疗前，ET-1分别低于同组治疗前，联合治疗组NO高于尼莫地平组， ET-1低于尼莫地平组（P＜0.05）。治疗期间两组头晕恶心、乏力、肠胃不适发生率及不良反应总发生率比较，差异 无统计学意义（P＞0.05）。结论　天麻素注射液联合尼莫地平治疗急性脑梗死的疗效确切，可提高患者日常生活活动 能力及改善神经功能，降低炎症因子，调节血管内皮因子，且安全可靠。

Abstract：

Objective To investigate the clinical efficacy of gastrodin injection combined with nimodipine in the treatment of acute cerebral infarction and their effect on inflammatory factors and vascular endothelial factors of patients. Methods This study was a single blind, randomized controlled trial. A total of 92 acute cerebral infarction patients admitted to the 901st Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from March 2019 to February 2022 were selected. The patients were divided into combined treatment group (n=46) and nimodipine group (n=46) using a random number table method. Both groups received anticoagulation, anti platelet aggregation, control of blood lipids, blood sugar, blood pressure and other basic treatment. Nimodipine group was given nimodipine orally on the basis of basic treatment, and combined treatment group was given gastrodin injection intravenously on the basis of nimodipine group. The treatment time of both groups was 14 days. The clinical efficacy, daily living ability (evaluated by Barthel Index) , neurological function [evaluated by National Institute of Health Stroke Scale (NIHSS) score] , inflammatory factors [tumor necrosis factor α (TNF-α) , interleukin 8 (IL-8) ] , vascular endothelial factors [nitric oxide (NO) , endothelin 1 (ET-1) ] before and after treatment and incidence of adverse reactions during treatment were compared between the two groups. Results After treatment, the clinical efficacy of combined treatment group was better than that of nimodipine group (P < 0.05) . After treatment, the Barthel Index of the two groups was higher than that before treatment, the NIHSS score was lower than that before treatment, respectively, the Barthel Index in combined treatment group was higher than that in nimodipine group, and the NIHSS score in combined treatment group was lower than that in nimodipine group (P < 0.05) . After treatment, the TNF-α, IL-8 of the two groups were lower than those before treatment, respectively, the TNF-α, IL-8 in combined treatment group were lower than those in nimodipine group (P < 0.05) . After treatment, the NO of the two groups was higher than that before treatment, the ET-1 was lower than that before treatment, respectively, the NO in combined treatment group was higher than that in nimodipine group, and the ET-1 in combined treatment group was lower than that in nimodipine group (P < 0.05) . There was no significant difference in the incidence of dizziness and nausea, fatigue and gastrointestinal discomfort, and total incidence of adverse reactions between the two groups (P > 0.05) . Conclusion Gastrodin injection combined with nimodipine in the treatment of acute cerebral infarction is effective, it can improve the patients' daily living ability and neurological function, reduce inflammatory factors, regulate vascular endothelial factors, and is safe and reliable.

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