학술논문
钙离子拮抗剂联合叶酸治疗伴H型高血压急性脑梗死的临床分析 / Clinical Analysis of Calcium Channel Blockers Combined with Folic Acid in The Treatment of Acute Cerebral Infarction with H-type Hypertension
Document Type
Academic Journal
Author
Source
系统医学. 1(9):33-37
Subject
Language
Chinese
ISSN
2096-1782
Abstract
目的：通过观察不同钙离子拮抗剂联合叶酸治疗对伴H型高血压急性脑梗死患者的血压水平、血浆同型半胱氨酸水平及神经功能评分影响,研究不同钙离子拮抗剂联合叶酸对伴有H型高血压的急性脑梗死的治疗作用及预后影响。方法选择2015年2—11月在邢台市人民医院住院的142例符合入组条件的患者随机分为治疗一组47例、治疗二组48例、对照组47例,治疗一组给予尼莫地平40 mg tid+叶酸2.5 mg/d,治疗二组给予尼群地平片10 mg bid+叶酸2.5 mg/d,对照组给予尼莫地平40 mg tid,其它用药3组基本相同。分别于治疗前,治疗后1、2、3周时分别测量血压水平、血浆同型半胱氨酸(Hcy)水平及血清叶酸(SFA)水平；另外,分别于治疗前、12周后测量患者NIHSS评分和Barthel指数评分。结果治疗3周时治疗一组患者收缩压(132.42±12.41)mmHg、舒张压(83.94±9.34)mmHg,治疗二组收缩压(131.27±11.78)mmHg、舒张压(82.63±10.03)mmHg均优于对照组收缩压(140.93±12.76)mmHg、舒张压(95.04±9.56)mmHg,差异有统计学意义(P<0.05),治疗一组血浆Hcy水平(9.86±2.73)μmol/L、SFA水平(19.3±0.24)nmol/L,治疗二组血浆Hcy水平(9.34±3.37)μmol/L、SFA水平(19.2±0.23)nmol/L均优于对照组血浆Hcy水平(14.43±3.42)μmol/L、SFA水平(8.8±2.2)nmol/L,差异有统计学意义(P<0.05),12周时治疗一组患者NIHSS评分(3.82±1.41)分、Barthel指数评分(68.94±9.34)分优于治疗二组NIHSS评分(4.57±1.78)分、Barthel指数评分(61.63±10.03)分及对照组NIHSS评分5.53±1.76)分、Barthel指数评分(54.04±9.56)分,差异有统计学意义(P<0.05)。 Pearson相关分析血浆Hcy与SFA的表达成负相关,治疗一组(r=-0.976, P=0.024<0.05),治疗二组(r=-0.984, P=0.016<0.05)。结论钙离子拮抗剂联合叶酸能有效控制伴H型高血压急性脑梗死患者的血压水平,降低血浆同型半胱氨酸,改善急性脑梗死患者预后,且尼莫地平联合叶酸治疗可能使预后获益更大,同时药物安全性高,经济性好,可以提高患者依从性,具有较好的临床推广价值。
Objective To find the therapeutic and prognostic effects of different Calcium Channel Blockers combined with folic acid on the patients with H type hypertension and cerebral infarction by observing the effect of the level of blood pressure、plasma homocysteine (Hcy)and Barthel index. Methods From Februay 2015 to November 2015 142 patients met the inclusion criteria were randomly divided into three groups.In the treatment group Ⅰ (n=47),the patients were cured with nimodipine 40 mg tid+folic acid 2.5mg qd,the patients of the treatment group Ⅱ (n=48)re-ceived nitrendipine 10mg bid+folic acid 2.5 mg qd,and the control group (n=47)were cured with nimodipine 40mg tid. The other medication of the three groups were same. Before treatment, after treatment 1 week, 2 weeks and 3 weeks,the blood pressure levels,plasma homocysteine levels and plasma folate levels were measured. In additionally, before treat-ment, and 12 weeks later, to assessed the patients with NIHSS score and Barthel Index score. Results After 3 weeks, The systolic blood pressure and the diastolic blood pressure of treatment groupⅠ (132.42±12.41)mmHg,(83.94±9.34) mmHg and treatment groupⅡ(131.27±11.78)mmHg,(82.63±10.03)mmHg, were better than that of contorl group(140.93± 12.76)mmHg,(95.04±9.56)mmHg,and the difference was statistically significant (P<0.05),the plasma homocysteine levels and serum folate acid levels of patients in treatment groupⅠ(9.86±2.73)μmol/L,(19.3±0.24)nmol/L and treatment groupⅡ(9.34±3.37)μmol/L,(19.2±0.23)nmol/L were better than that of control group(14.43±3.4)μmol/L,(8.8±2.2)nmol/L,and the different was statistically significant (P<0.05). The NIHSS scores (3.82±1.41)points of treatment groupⅠ after 12 weeks of treatment was lower than in the treatment groupⅡ (4.57±1.78)points and control group (5.53±1.76)points,and the difference was statistically significant(P<0.05). The Barthel index scores(68.94±9.34)of the treatment groupⅠafter 12 weeks of treatment was higher than in the treatment groupⅡ ( 61.63±10.03)points and control group (54.04±9.56) points,and the difference was statistically significant(P<0.05). Pearson correlation analysis showed that the expression of plasma Hcy levels and serum folate acid levels in the treatment groupⅠ(r= -0.976, P=0.024<0.05)and treatment groupⅡ (r= -0.984,P=0.016<0.05)was negatively correlated. Conclusion Calcium Channel Blockers combnation folic acid can effectively control the level of blood pressure and plasma Hcy of patients with H type hypertension and acute cere-bral infarction,and the nimodipine combnation folic acid were more conducive to improving the prognosis.Drug safety is high, the economy is good, will help improve patient compliance, suitable for clinical practice.
Objective To find the therapeutic and prognostic effects of different Calcium Channel Blockers combined with folic acid on the patients with H type hypertension and cerebral infarction by observing the effect of the level of blood pressure、plasma homocysteine (Hcy)and Barthel index. Methods From Februay 2015 to November 2015 142 patients met the inclusion criteria were randomly divided into three groups.In the treatment group Ⅰ (n=47),the patients were cured with nimodipine 40 mg tid+folic acid 2.5mg qd,the patients of the treatment group Ⅱ (n=48)re-ceived nitrendipine 10mg bid+folic acid 2.5 mg qd,and the control group (n=47)were cured with nimodipine 40mg tid. The other medication of the three groups were same. Before treatment, after treatment 1 week, 2 weeks and 3 weeks,the blood pressure levels,plasma homocysteine levels and plasma folate levels were measured. In additionally, before treat-ment, and 12 weeks later, to assessed the patients with NIHSS score and Barthel Index score. Results After 3 weeks, The systolic blood pressure and the diastolic blood pressure of treatment groupⅠ (132.42±12.41)mmHg,(83.94±9.34) mmHg and treatment groupⅡ(131.27±11.78)mmHg,(82.63±10.03)mmHg, were better than that of contorl group(140.93± 12.76)mmHg,(95.04±9.56)mmHg,and the difference was statistically significant (P<0.05),the plasma homocysteine levels and serum folate acid levels of patients in treatment groupⅠ(9.86±2.73)μmol/L,(19.3±0.24)nmol/L and treatment groupⅡ(9.34±3.37)μmol/L,(19.2±0.23)nmol/L were better than that of control group(14.43±3.4)μmol/L,(8.8±2.2)nmol/L,and the different was statistically significant (P<0.05). The NIHSS scores (3.82±1.41)points of treatment groupⅠ after 12 weeks of treatment was lower than in the treatment groupⅡ (4.57±1.78)points and control group (5.53±1.76)points,and the difference was statistically significant(P<0.05). The Barthel index scores(68.94±9.34)of the treatment groupⅠafter 12 weeks of treatment was higher than in the treatment groupⅡ ( 61.63±10.03)points and control group (54.04±9.56) points,and the difference was statistically significant(P<0.05). Pearson correlation analysis showed that the expression of plasma Hcy levels and serum folate acid levels in the treatment groupⅠ(r= -0.976, P=0.024<0.05)and treatment groupⅡ (r= -0.984,P=0.016<0.05)was negatively correlated. Conclusion Calcium Channel Blockers combnation folic acid can effectively control the level of blood pressure and plasma Hcy of patients with H type hypertension and acute cere-bral infarction,and the nimodipine combnation folic acid were more conducive to improving the prognosis.Drug safety is high, the economy is good, will help improve patient compliance, suitable for clinical practice.