Effect of pretreatment with butylphthalide injection on prognosis of intravenous thrombolysis in ultra-early acute cerebral infarction / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score 3.87±3.46 vs. 7.37±4.18, BI score 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.