于丽波 王帅 姜瀛

[摘要] 目的 探討银杏内酯注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的效果。 方法 分析中国人民解放军第二一一医院神经内二科2015年5月～2017年7月收治的106例急性缺血性脑卒中患者临床资料，依据治疗方式进行分组，对照组（阿替普酶治疗）53例和观察组（银杏内酯注射液联合阿替普酶治疗）53例，两组均治疗14 d。观察两组患者治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分、纤维蛋白原（FIB）、凝血酶原时间（PT）、凝血酶时间（TT）、生活质量评分、日常生活能力（Barthel）指数，观察两组患者临床疗效、并发症情况。 结果 两组患者治疗前NIHSS评分、改良mRS评分、FIB、PT、TT、生活质量评分和Barthel指数比较，差异均无统计学意义（P > 0.05）。治疗后，两组患者NIHSS评分、改良mRS评分均低于本组治疗前，生活质量评分和Barthel指数均高于本组治疗前，差异均有统计学意义（P < 0.05）。治疗后，观察组NIHSS评分、改良mRS评分均低于对照组，生活质量评分和Barthel指数均高于对照组，差异均有统计学意义（P < 0.05）。对照组治疗后FIB低于治疗前，PT、TT高于治疗前（P < 0.05），观察组治疗前后FIB、PT、TT比较，差异均无统计学意义（P > 0.05）。治疗后，观察组FIB高于对照组，PT、TT低于对照组，差异均有统计学意义（P < 0.05）。观察组临床治疗总有效率高于对照组、并发症总发生率低于对照组，差异均有统计学意义（P < 0.05）。 结论 银杏内酯注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中患者，可以更好地改善患者的神经功能和生活质量，对于凝血功能影响较小，效果明显，并发症少，值得临床推广应用。

[关键词] 银杏内酯注射液;阿替普酶;静脉溶栓;急性缺血性脑卒中;神经功能

[中图分类号] R743.3          [文献标识码] A          [文章编号] 1673-7210（2019）03（a）-0140-04

[Abstract] Objective To explore effect of venous thrombolysis treatment of acute ischemic stroke with Ginkgo Injection combined with Alteplase. Methods A total of 106 cases′ clinical data of acute ischemic stroke in the Second Division of Neurology Department， Chinese People′s Liberation Army 211 Hospital from May 2015 to July 2017 were selected and analyzed. All the cases were divided by different treatment method， with 53 cases in the control group （Alteplase therapy） and 53 cases in the observation group （Ginkgo Injection combined with Alteplase therapy）. The two groups were treated for 14 days. The National Institute of Health Stroke Scale （NIHSS） scores， improve mRS score， fibrinogen （FIB）， prothrombin time （PT）， thrombin time （TT）， life quality scores， activity of daily living Barthel index of the two groups were observed and the clinical efficacy， complications of the two groups were observed. Results Before treatment， the NIHSS scores， improve mRS scores， FIB， PT， TT， life quality scores and Barthel index of two groups were compared and there was no statistically significant differences （P > 0.05）. After treatment， the NIHSS scores， improve mRS scores in the two groups were lower than those in the two groups， life quality scores and Barthel index in the two groups were higher than those before treatment， the differences were significant （P < 0.05）. After treatment， the NIHSS scores， improve mRS scores in the observation group were lower than those in the control group while the life quality scores and Barthel index were higher than those in the control group， the differences were significant （P < 0.05）. After treatment， FIB was lower than that before treatment and PT， TT were higher than those before treatment in the control group （P < 0.05）. But there was no significant difference between FIB， PT， TT before and after treatment in the treatment group （P > 0.05）. After treatment， FIB in the observation group was higher than that in the control group and PT， TT were lower than those in the control group， all the differences were statistically significant （P < 0.05）. The total clinical treatment efficiency of the observation group was higher than that in the control group， and total complications rate were lower than the control group， the differences were statistically significant （P < 0.05）. Conclusion The venous thrombolysis treatment of acute ischemic stroke with Ginkgo Injection combined with Alteplase could improve nerve function and life quality， by which the influence of blood coagulation dysfunction is little， the effect is remarkble， complications is few， and it is worth of promotion.

[Key words] Ginkgo Injection; Alteplase; Venous thrombolysis; Acute ischemic stroke; Nerve function

急性缺血性脑卒中属于造成人类死亡的三大疾病之一，其在脑卒中总发生率中比例约80%，临床症状主要以肢体无力、麻木，口齿不清，语言理解有困难，视力降低、呕吐伴随眩晕等[1-2]。急性缺血性脑卒中发生的原因比较复杂，可能和血栓造成脑供血动脉阻塞有关，同时与血脂代谢水平异常、血小板聚集、血管内皮细胞损伤和脑血管阻塞也有一定的关系[3-4]。急性……