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目的评价国产氯吡格雷联合桂哌齐特、舒血宁注射液治疗椎基底动脉供血不足(VBI)所致眩晕的有效性与安全性。方法选取104例VBI患者,随机分为治疗组54例与对照组50例。对照组予马来酸桂哌齐特及丹红注射液静脉滴注,治疗组在对照组基础上加用氯吡格雷。连续治疗7~21d后评估患者的眩晕程度,采用TCD检测椎基底动脉血流速度,同时随访30d记录短暂性脑缺血(TIA)及脑梗死发生人数。结果治疗组0~2h起效(48.1%vs.28.0%)的患者及0~6h起效(85.2%vs.58.0%)的患者占比率显著高于对照组,2组比较差异有统计学意义(P<0.05);治疗组显效率(64.8%vs.42.0%)、总有效率(92.6%vs.76.0%)均明显高于对照组,2组比较差异有统计学意义(P<0.05)。TCD检测治疗组与对照组治疗后TCD血流速度(cm/s)比较,左侧椎动脉比较为(44.2±10.7)vs.(42.8±11.6)、右侧椎动脉比较为(42.8±10.7)vs.(37.6±10.8)、基底动脉比较为(43.2±10.3)vs.(41.7±10.4),治疗组的血流速度改善更为明显。2组比较差异有统计学意义(P<0.05);治疗组30d内无发生TIA或脑卒中病例,对照组发生TIA 3例,1例进展为脑卒中,发生率为8%。2组比较差异有统计学意义(P<0.05);2组治疗过程中均未发生严重的不良反应。结论氯吡格雷联合桂哌齐特、丹红注射液可显著改善椎—基底动脉供血不足所致眩晕,治疗过程极少发生不良反应,值得临床推广应用。
Objective To evaluate the efficacy and safety of domestic clopidogrel combined with cinepazide and shuxuening injection in treating vertigo caused by vertebrobasilar insufficiency (VBI). Methods 104 cases of VBI were selected and randomly divided into treatment group (54 cases) and control group (50 cases). The control group was administered with cinepazide maleate and Danhong injection intravenously. The treatment group was given clopidogrel on the basis of the control group. The degree of vertigo was evaluated after 7 ~ 21 days of continuous treatment. The vertebrobasilar artery blood flow velocity was detected by TCD. At the same time, the number of transient ischemic attack (TIA) and the number of cerebral infarction were recorded after 30 days of follow-up. Results The proportion of patients who achieved 0 ~ 2 h (48.1% vs.28.0%) and 0 ~ 6 h (85.2% vs.58.0%) in the treatment group was significantly higher than that of the control group, the difference was statistically significant (P <0.05). The effective rate (64.8% vs.42.0%) and total effective rate (92.6% vs.76.0%) in the treatment group were significantly higher than those in the control group, with significant difference between the two groups (P <0.05) . The TCD blood flow velocity (cm / s) in the treatment group and the control group was (44.2 ± 10.7) vs. (42.8 ± 11.6) vs. (42.8 ± 10.7) vs. the right vertebral artery (37.6 ± 10.8) and basilar artery (43.2 ± 10.3) vs. (41.7 ± 10.4), the improvement of blood flow velocity in the treatment group was more obvious. There was no significant difference between the two groups (P <0.05). No TIA or stroke occurred within 30 days in the treatment group, 3 cases in the control group and 3 cases in the control group. The incidence of stroke was 8% in 1 case. The difference between the two groups was statistically significant (P <0.05). No serious adverse reactions occurred in the two groups during the course of treatment. Conclusion Clopidogrel combined with Cinepazide and Danhong injection can significantly improve dizziness caused by insufficiency of vertebro-basilar artery. Adverse reactions are rare in the course of treatment, which is worthy of clinical application.