The Clinical Observation On Treatment Of Vertebrobasilar Insufficiency By Manxintuo And Analysis Of The Change Of Cerebral Hemodynamics

Background and Objective:Vertebrobasilar Insufficiency（VBI）is a conditiondue to insufficient blood supply to certain parts of the brain,leading to varioustemporary and/or permanent symptoms.Symptoms can present a complex variedclinical pictures,including vertigo or dizziness,gait disturbances ordystaxia,impaired vision,position related nystagmus,difficulty talking,dropattack,tinnitus and/or deafness,weakness or numbness on one or both sides of thebody. VBI is a common ailment in middle-aged and old men,its morbidity isincreasing year by year.Atherosclerotic stenosis or occlusion, cerebrovascularmalformations,vasospasm and arteritis, cervical spondylosis and cervical spinalinjury, anemia, hypotension play most important roles in the etiology ofVBI.Cerebral hypoperfusion and the decompensation of collateral circulation canlead to intracranial hemodynamic abnormity.The decrease of blood supply of braintissue may result in VBI.If be treated not in time,cerebral ischemia is verylikely,and causes worse symptoms of neurological impairment.Transcranial Doppler ultrasound (TCD) is useful to assess stenosis orocclusion of extra-and intra-cranial arteries,and it also can find heteroplasia ofarteries and the collateral circulation compensatory capacity. TCD can be used toindicate for monitoring blood flow velocity,blood flow spectrum and flowdirection.Therefore, TCD is the important non-invasive,reliable,economical andwidely applicated detection methods of hemodynamic assessment and changes.Prostaglandin E1(PGE1) is a potent vasodilator that increases peripheral bloodperfusion.In addition,PGE1has several pharmacological effects, includinginhibition of platelet aggregation and thromboxane A2, amelioration of therheological property of blood,cytoprotection, alleviating cerebral vasospasm andinhibition of oxygen free radicals.Lipo-PGE1(Prostaglandin E1incorporated in alipid microsphere with an average particle size of0.2μm) is one of improved formulations about PGE1.Some studies have shown that lipo-PGE1is effective atlower doses,high-efficacy and resulted in fewer side effects. Treatment ofvertebrobasilar insufficiency and VBI seizures controlled in its medical therapycontain platelet aggregation,improving blood circulation,relieving cerebralvasospasm and anticoagulant therapy.Because of the above pharmacologicaleffects,Lipo-PGE1has been widely used in the treatment of peripheral vasculardisease, ischaemic heart disease and vertebrobasilar ischemia and so on.Therefore,we treated the patients of vertebrobasilar insufficiency byManxintuo.Detecting blood flow velocity by transcranial Doppler ultrasound and the changeof clinical efficacy scores judge the therapeutic effect.Subjects and methods: In our clinical investigation,50cases with vertebrobasilarinsufficiency in the department of Neurology of the third hospital Affiliated toJilin University in from June2011to December2011were randomly divided intotwo groups(25cases in the treatment group and25cases in the controlgroup).Patients in the treatment group were treated by combined injection ofManxintuo and Ozagrel. Patients in the control group were treated by combinedinjection of Danhong and Ozagrel.The therapy lasted7days.All patients receivedthe examination of TCD(Blood flow parameters revolved in vertebrobasilar arterysystem such as systolic velocity and diastolic velocity were kept detailed records)and assessment of clinical symptoms and signs before and after the treatments.Allof the data apply SPSS19.0package for processing,x±s is applied for quantitativedata,t test is applied in the test of significance of mean number.Comparisons ofpre-and post-treatment between groups were tested by t test.Result: After treatment the patients of VBI had symptomatic improvementrespectively in different degrees in the two group. In the treatment and controlgroup,the score of clinical symptoms and signs after the treatment was obviouslylower than that before treatment.There were significant difference.This suggestedthat Manxintuo and Danhong might significantly improve symptoms andsigns.However,mean score comparisons of clinical symptoms and signs was not different significantly after the treatment between the two groups (P>0.05).In theparameter about TCD,before treatment,there were no significant differences inblood flow velocity(Vs,Vd) in between two groups(P>0.05). In constrast,the bloodflow velocity of LVA,RVA and BA had different degrees of improvement aftertreatment.In the experiment group,the blood flow velocity increasedobviously,with marked difference from the control group(P<0.05).Theimprovement of the treatment group was better than of the control group insystolic velocity and diastolic velocity.Conclusion: Alprostadil injection(Lipo-PGE1,Manxintuo) can improve theclinical symptoms of VBI significantly. The blood flow velocity of vertebrobasilarartery system had brought about a marked increase after treated byLipo-PGE1(Manxintuo).Comparisons of the assessment of clinical symptoms andthe change of blood flow velocity,it was concluded that Lipo-PGE1increased thecerebral blood flow,and improved the energy of metabolism of cerebralischemia.On top of that,it is effective at lower doses,high-efficacy and resulted infewer side effects.Therfore, Lipo-PGE1(Manxintuo) is a routine and an efficientdrug in the treatment of vertebrobasilar insufficiency.