Joint Butylphthalide Defibrase, Anti-platelet Multi-target Treatment Of Progressive Cerebral Infarction

Progressive cerebral infarction is one of the difficult and hot spots in the field of neurology,due to the pathogenesis of complex,varied clinical manifesta-tions and poor prognosis.More factors of progressive cerebral infarction are mutual interaction and complex,right now the recognized risk factors, including blood pressure, blood glucose,blood lipid abnormalities,obesity,high fibrinogen and other factors,which are closely related to progressive cerebral infarction is still more views in literature.Increase awareness of the status and risk factors for progressive cerebral infarction is important in the level of disease primary prevention and clinical work. Even early risk prediction,early disease assessment and early intervention treatment of progressive cerebral infarction, it is important in reducing the incidence of disease and improving the cure rate of the clinical disease and prognosis.At present the drug of the treatment for progressive cerebral infarction, ultra-early thrombolytic of the application is more skilled within time window.If the treatment of acute cerebral infarction over time window,in particular treatment to prevent progressive cerebral infarction,including anti-platelet aggregation,defibrase,anticoagulant treatment.But because anti-platelet and fibrinolytic drugs to improve cerebral microcirculation and the promotion of brain cell metabolism are limitedand often only are applicated in acute phase, so improving the PCI neurological improvement is still not satisfactory.Although a significant reduction in the mortality rate and morbidity,but are often limited to the acute phase applications, sub-acute phase of limited application.Therefore, in improve neurological function of patients with progressive cerebral infarction is still not satisfactory.Butylphthalide is an China's independent property rights of new drugs independent research and development,now has completed phase IV clinical studies.Drugs mechanism include:increasing ischemic district cerebral perfusion, reducing infarct area,improving mitochondrial function,improving cerebral metabolism,especially improving cerebral ischemia District Microcirculation obviously. It has been approved the treatment of cerebral vascular disease applied to 1 line medication. In early large clinical cases observation,the drug's efficacy is recognized.Currently clinical trials of the butylphthalide combined defibrase, antiplatelet drug therapy for progressive cerebral infarction have not been reported at home and abroad.Defibrase,anti-platelet therapy is mainly used to prevent blood clots progress and restore the treatment of ischemic vascular perfusion,if can be used to joint butylphthalide,it can effectively improve ischemic brain microcirculation,may improve the prognosis of patients with effective and guide clinical work.In recent years foreign scholars also have suggest patients to propose the treatment of joint,multi-targeted therapy program,especially those with acute cerebral infarction and a tendency to progress in the early cerebral infarction.In this paper,we will examine the characteristics of cerebral infarction,and observed the clinical efficacy of Butylphthalide joint defibrase,anti-platelet therapy.277 patients within 72 hours incidence of cerebral infarction,were used to study the relationship between the infarction type and progress, compare the the statistical analysis of time in patients with progressive cerebral infarction.These patients who came form May to November 2009 in Department of Neurology of Jilin University China-Japan Friendship Hospital.Recording 72 progressive patients and 205 cases of clinical non-progress patients,and observing progress indicators, risk factors. Patients of progressive cerebral infarction were randomly divided into A group (butylphthalide combined defibrase ,antiplatelet) 35 cases,B group (defibrase,antiplatelet) 32 cases ,patients of non-progress were divided into A group 42 cases, B group 45 cases, comparisons of the A,B before and after treatment the efficacy of the two groups.Progress rates of total anterior circulation,posterior circulation,partial anterior circulation group compared with the general progress of the rate was significantly different (P <0.05),complete anterior circulation,has the highest rate of progress , posterior circulation account for the largest proportion of progressiv patients. Patients of carotid infarct within 24 hours to progress were more common (P<0.05), patients of vertebrobasilar infarction in 24 to 72 hours and 72 hours to 1 week compared with the rate of progress of anterior circulation's patients with significant differences (P<0.05).Progress patients and non-progress patients with single-factor analysis,dizziness,arteriosclerosis-prone plaque or stenosis, low-density lipoprotein (LDL) abnormal,white blood cell (WBC) increasing in both groups had significant difference (P<0.05),while diabetes, headache, fever, triglyceride (TG) and other factors showed no significant difference (P>0.05); And multivariate logistic regression analysis of the above significantly different indicators showed that carotid atherosclerosis-prone plaqueor stenosis, hyperten- sion were statistically significant than other factors (P<0.05). NIHSS score of progress infarction A,B group showed no significant difference (P>0.05) on 3 days,7 days after treatment,NIHSS score of 14 days after the two groups was significant difference (P<0.05).Non-progression group A, B group after treatment of 3 days showed no significant difference (P>0.05), in the treatment of 7 days and 14 days after the two rates are significantly different (P<0.05).The Barthel score and clinical score between the two groups had no significant difference (P>0.05).Based on the characteristics of progressive cerebral infarction,and butylph-thalide combined defibrase,antiplatelet therapy on cerebral infarction progress, reaching the following conclusions:TACI has greater progress rate in infarction OCSP classification,POCI patients accounted for a higher proportion of all;Patients of ICAS infarction within 24 hours were more common by cerebral vascular anatomy typing,VBAS infarction with onset after 24 hours to 1 week was more common progress;Hypertension,LDL abnormal,WBC increasing, vascular plaque or stenosis,dizziness were risk factors for PCI,in which plaques or stenosis,hypertension were more closely with PCI;Butylphthalide combined defibrase,antiplatelet multi-targeted treatment of progressive and non- progressive cerebral infarction can improve neurological function, combination therapy is superior to singled efibrase,anti-platelet therapy.