标题：西洛他唑联合阿司匹林治疗老年腔隙性脑梗死的疗效及对患者脑损伤、血液流变学及脑血流动力学的影响

      作者：郝涛 1，陈斌 2，沈晓娟 3    1.宝鸡高新医院神经内科，陕西 宝鸡 721000；2.西安凤城医院神经外科，陕西 西安 710018；3.西安大兴医院神经内科，陕西 西安 710016

      卷次： 2022年33卷9期

      【摘要】 目的 观察西洛他唑联合阿司匹林治疗老年腔隙性脑梗死(LI)的临床效果，并探讨其对患者脑损伤、血液流变学及血流动力学的影响。方法 选取2019年1月至2020年11月宝鸡高新医院神经内科收治的102例老年LI患者为研究对象，采用随机数表法分为观察组和对照组，每组51例。两组患者均予以基础治疗，对照组患者在基础治疗上应用阿司匹林治疗，观察组患者则在基础治疗上联合应用阿司匹林和西洛他唑治疗，疗程均为12周。比较两组患者治疗后的疗效，以及治疗前后的脑损伤血清指标[神经元特异性烯醇化酶(NSE)、内皮素(ET)、降钙素基因相关肽(CGRP)]、血液流变学指标(全血黏度切变率、血浆黏度、血细胞比容)、脑血流动力学[平均流速(Vmean)、阻力指数(RI)、搏动指数(PI)]的差异。结果 治疗12周后，观察组患者的总有效率为90.20%，明显高于对照组的74.51%，差异有统计学意义(P<0.05)；治疗12周后，两组患者血清NSE、ET水平、全血黏度切变率、血浆黏度、血细胞比容、RI、PI均较治疗前降低，且观察组的上述各项指标依次为(12.85±2.26) μg/L、(63.03±7.24) ng/L、3.74±0.91、(1.42±0.27) mPa·s、(0.42±0.06)%、0.61±0.14、0.63±0.15，明显低于同期对照组的(13.98±2.17) μg/L、(68.58±8.32) ng/L、4.35±1.03、(1.58±0.28) mPa·s、(0.46±0.07)%、0.72±0.15、0.74±0.16，差异均有统计学意义(P<0.05)；治疗 12周后，两组患者的血清CGRP水平、Vmean均较治疗前上升，且观察组的上述各项指标依次为(47.83±6.24) ng/L、(54.27±9.67) cm/s，高于同期对照组的(45.18±5.32) ng/L、(49.68±8.61) cm/s，差异均有统计学意义(P<0.05)。结论 西洛他唑联合阿司匹林治疗老年LI患者疗效显著，其不仅能调节患者的血清NSE、ET、CGRP水平，而且还能改善患者的血液流变学及脑血流动力学情况。
      【关键词】 老年；腔隙性脑梗死；阿司匹林；西洛他唑；神经元特异性烯醇化酶；疗效
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2022）09—1141—04

Efficacy of cilostazol combined with aspirin in the treatment of elderly lacunar infarction and its influence oncerebral injury, hemorheology, and cerebral hemodynamics of patients.
HAO Tao 1, CHEN Bin 2, SHEN Xiao-juan 3.1. Department of Neurology, Baoji High-Tech Hospital, Baoji 721000, Shaanxi, CHINA; 2. Department of Neurosurgery,Xi'an Fengcheng Hospital, Xi'an 710018, Shaanxi, CHINA; 3. Department of Neurology, Xi'an Daxing Hospital, Xi'an710016, Shaanxi, CHINA
【Abstract】 Objective To observe the clinical effects of cilostazol combined with aspirin in treating elderly la-cunar infarction (LI), and to explore the influence on cerebral injury, hemorheology, and hemodynamics of patients.Methods A total of 102 elderly patients with LI who were treated in Department of Neurology, Baoji High-Tech Hospi-tal between January 2019 and November 2020 were selected as the research subjects, and they were divided into an ob-servation group (n=51) and a control group (n=51) by using the random number table method. Based on basic treatment,the patients in the control group were treated with aspirin, while those in the observation group were given aspirin com-bined with cilostazol on the basis of basic treatment, for 12 weeks. The efficacy after treatment, and differences in serumindexes of cerebral injury [neuron-specific enolase (NSE), endothelin (ET), calcitonin gene-related peptide (CGRP)],hemorheology indexes (whole blood viscosity shear rate, plasma viscosity, hematocrit), and cerebral hemodynamics[mean velocity (Vmean), resistance index (RI), pulsatility index (PI)] before and after treatment were compared betweenthe two groups. Results After 12 weeks of treatment, the total effective rate in the observation group was 90.20%, significantlyhigher than 74.51% in the control group (P<0.05). After 12 weeks of treatment, the levels of serum NSE and ET, whole blood vis-cosity shear rate, plasma viscosity, hematocrit, Vmean, RI, and PI in the two groups were reduced compared with those before treat-ment; the above indexes were (12.85±2.26) μg/L, (63.03±7.24) ng/L, 3.74±0.91, (1.42±0.27) mPa·s, (0.42±0.06)%, 0.61±0.14,and 0.63±0.15 in the observation group, which were significantly lower than (13.98±2.17) μg/L, (68.58±8.32) ng/L,4.35±1.03, (1.58±0.28) mPa·s, (0.46±0.07)%, 0.72±0.15, and 0.74±0.16 in the control group (P<0.05). Serum CGRP lev-