| One of the most effective treatments for ultra early cerebral infarction is intravenous thrombolytic therapy with alteplase,but the thrombolytic effect is related to many factors,and there are few reports on the correlation with TCM syndromes.The efficacy of alteplase in the treatment of intravenous thrombolysis was divided into early efficacy and long-term efficacy.Early ineffective intravenous thrombolysis is an independent risk factor for poor long-term efficacy.Alteplase and other thrombolytic drugs have the function of breaking blood and smashing blood,but they have the effect of consuming Qi and suffocating Qi.The qi deficiency is unable to conduct blood,resulting in the stasis of blood flow,leaving neurological deficits such as limb hemiplegia.Qi.The deficiency of Qi fails to astringing the blood,causing it breaking out the vessels and disease worsening.This study is intended to conduct a two-part study to analyze and summarize the influencing factors on efficacy of the treatment of ineffective early intravenous alteplase,and to observe the effect of qi and activating blood circulation on the long-term outcome of patients with early ineffectiveness.Long-term benefits of therapeutic drugs may better guide the overall outcome of stroke.In this study,we used the in-hospital made Qilong Mixture in our hospital,originated from the prescription of Buyang Huanwu Decoction,which has the effect of tonifying qi,promoting blood circulation and collaterals,in order to provide certain clinical evidence for the therapeutic mechanism of traditional Chinese medicine in treating patients with cerebral infarction.The first part The study of the influencing factors of early intravenous thrombolysis with alteplase in acute ischemic strokeObjective: To investigate the influencing factors affecting the early thrombolytic failure of alteplase in acute ischemic stroke.Methods: This study enrolled patients in the emergency encephalopathy department of the Eastern Hospital of Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from October 1,2016 to January 7,2019.The acute ischemic effect of intravenous thrombolytic therapy with alteplase within 4.5 hours of onset.In patients with stroke,the clinical data between the early effective ineffective thrombolytic group and the early ineffective thrombolytic group were compared,and the factors that may affect the early ineffectiveness of alteplase in intravenous thrombolysis were compared by univariate analysis and multivariate logistic regression analysis.Results: A total of 153 patients met the inclusion criteria,including 84 patients(54.9%)with early thrombolysis,69 patients(45.1%)with early thrombolysis,and 5 patients(3.27%)with intracranial hemorrhage after thrombolysis.14 patients(9.2%)were aggravated after thrombolysis.Univariate analysis showed that the difference between the early thrombolytic group and the thrombolytic early effective group(16.7%(14/84),2.9%(2/69),respectively)was statistically significant(P< 0.05),the remaining baseline data(gender,age,previous hypertension,previous diabetes history,previous atrial fibrillation or atrial flutter history,NIHSS0-7,8-14,and ≥15 points,time to onset to thrombolysis,There were no significant differences in baseline systolic blood pressure,baseline diastolic blood pressure,and baseline blood glucose levels(P>0.05).Multivariate logistic regression analysis showed that the baseline NIHSS score was less than or equal to 5 points(OR=2.366,95% CI 1.128~4.961,P=0.023),qi deficiency and blood stasis syndrome after thrombolysis(OR=8.345,95% CI 1.645~42.305),P=0.010)is an independent risk factor for early ineffective after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke.Conclusion: Light stroke(NIHSS less than or equal to 5 points)and qi deficiency and blood stasis syndrome after thrombolysis are independent risk factors for early inactivation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke.The second part The study of effect of Qilong Mixture on the clinical intervention of patients with acute ischemic stroke and ineffectiveness of alteplase in early intravenous thrombolysisObjective: To investigate the efficacy of the in-hospital preparation of tonifying Qi and Blood Stasis in treating patients with early thrombolytic therapy,and to explore the effect of invigorating qi and activating blood circulation on the long-term efficacy of thrombolysis.Methods: Randomized controlled clinical trials were used to classify patients with early intravenous thrombolysis who met the inclusion criteria into control group and experimental group.The control group was treated with conventional western medicine such as aspirin,atorvastatin calcium and edaravone.The group was treated with Qilong Mixture for 90 days on the basis of conventional western medicine treatment.The NIHSS score,m RS score,BI index and the scores were recorded 24 hours after thrombolysis,7 days after treatment,21 days after treatment and 90 days after treatment.TCM syndrome scores were assessed 24 hours after thrombolysis and 90 days after treatment.The mortality,intracranial hemorrhage conversion rate and adverse reactions were followed up for 3 months.The differences between the treatment group and the control group were analyzed.The effect of Qilong Mixture on the improvement of neurological function and long-term outcome in patients with early intravenous thrombolysis.Results: There were 64 cases in this study,0 cases were lost in the loss of follow-up,2 cases died within 3 months,and the bleeding was converted into 0 cases.The patients were randomly divided into the control group(31 cases)and the experimental group(31 cases).There was no significant difference in the baseline factors(sex,age,past medical history)(P>0.05).(1)Good rate of m RS: 24 hours after thrombolysis,7 days after treatment,21 days after treatment,90 days after treatment,there was no significant difference in the good rate of m RS between the control group and the treatment group(P>0.05).In the treatment group,the difference between the good rate of m RS at 21 days and 90 days after treatment and the 24 hours after thrombolysis was statistically significant(P<0.05);the difference between 90 days after treatment and 7 days after treatment was statistically significant.Significance(P<0.05),there was no significant difference between the 7 days after treatment and 24 hours after thrombolysis,21 days after treatment and 7 days after treatment,90 days after treatment and 21 days after treatment(P>0.05)..In the control group,the difference between the good rate of m RS and the 24 hours after thrombolysis was statistically significant(P<0.001);the difference between 90 days after treatment and 7 days after treatment was statistically significant(P <0.05),no difference between 7 days after treatment,21 days after treatment and 24 hours after thrombolysis,21 days after treatment and 7 days after treatment,90 days after treatment and 21 days after treatment,and 7 days after treatment Academic significance(P>0.05).(2)NIHSS score: There was a statistically significant difference in NIHSS between the treatment group and the control group at 90 days after treatment(P<0.05).There was no significant difference in NIHSS between the two groups at 24 hours after thrombolysis,7 days after treatment,and 21 days after treatment(P>0.05).In the control group,the NIHSS scores at 21 and 90 days after treatment decreased from 24 hours after thrombolysis(P<0.05),and 21 days after treatment decreased from 7 days after treatment(P<0.05).After treatment,90 days after treatment 7 days of decline(P<0.05),the difference between 7 days after treatment and 24 hours after thrombolysis,90 days after treatment and 21 days after treatment was not statistically significant(P>0.05);in the treatment group,treatment The NIHSS scores decreased after 21 days and 90 days after thrombolysis(P<0.05),and 21 days after treatment decreased compared with 7 days after treatment(P<0.05).90 days after treatment were compared with 7 days and 21 days after treatment.There was no significant difference in NIHSS between the 7 days after treatment and the 24 hours after thrombolysis(P>0.05).(3)BI independence rate: 24 hours after thrombolysis,7 days after treatment,21 days after thrombolysis,90 days after thrombolysis,there was no significant difference in the independent rate of BI between the treatment group and the control group(P>0.05).).In the treatment group,the difference between the BI independence rate and the 24 hours after thrombolysis was statistically significant(P<0.05)at 21 days after treatment and 90 days after treatment;7 days after treatment and 24 hours after thrombolysis,21 after treatment.There was no significant difference between days and 7 days after treatment,90 days after treatment and 21 days after treatment(P>0.05).In the control group,the difference between the BI independence rate and the 24 hours after thrombolysis was statistically significant(P<0.05).The difference between the BI independence rate and the 7 days after treatment was statistically significant.Significance(P<0.05);7 days after treatment,21 days after treatment and 24 hours after thrombolysis,21 days after treatment and 7 days after treatment,the difference between 90 days after treatment and 21 days after treatment was not statistically significant.(P>0.05).(4)TCM syndrome efficacy: There was a statistically significant difference in the efficacy of TCM syndrome between the treatment group and the control group(P<0.05).Conclusions:(1)The effect of Qilong Mixture on m RS good rate,NIHSS score and BI independence rate in patients with early ischemic stroke and alteplase thrombolysis was not significantly improved.(2)Qilong Mixture can improve the TCM syndrome scores of patients with early thrombolytic failure and improve the quality of life of patients. |
PDF Full Text Request