Research Of The Effect Of Dl-3n-Butylphthalide Injection On CBFs By Xe-CT In Acute Cerebral Infarction And Its Curative Effect

Cerebral vascular diseases have become the principal diseases that hazard human's health, the second killer leading to death and the primary reason for mutilation. The incidence of cerebral vascular diseases in China still increases apparently during the past years, however, ischemic cerebral vascular diseases take up 70% of all cerebral vascular diseases. Until now, super-inchoate rt-PA thrombolysis therapy is certified to be the most effective therapeutic method by evidence-based medicine. But even in the USA which has developed Health Service System and higher medicine levels, only less than 5% patients could benefit from rt-PA thrombolysis therapy. Obviously, this proportion is much less in China. Thus it is extremely necessary to find out a therapeutic method which can recuperate the perfusion of ischemic brain tissue effectively and promptly and benefit most patients. Animals researches indicate that dl-3n-butylphthalide can multiply CBF of ischemic brain tissue and its peripheries, improve energy metabolism of ischemic brain tissue, protect mitochondria, inhibit inflammatory reaction after ischemia, protect endothelial cells and inhibit apoptosis through increasing free radicals clearance and restraining calciumion step-up. Therefore dl-3n-butylphthalide can increase CBF of ischemic brain tissue, decrease sizes of cerebral infarction and nervous afunction. Our research use Xe-CT, which can provide highly accurate and quantitative CBF values without injuring, to detect the change of CBF prior and post treatment of dl-3n-butylphthalide injection. In this research, we aim to investigate the clinical curative effect of dl-3n-butylphthalide to acute cerebral infarction of carotid artery system and how dl-3n-butylphthalide affects CBFs.We choose patients of cerebral infarction of carotid artery system within 48 hours, giving them dl-3n-butylphthalide injection or sodium ozagrel injection randomly intravenously guttae for 14 days. Xe-CT is used to detect CBF on the first day and the 14^th day and patients are evaluated by NIHSS scale to observe curative effect.The results are as follows: NIHSS scores of therapeutic group post-treatment are obviously lower than prior treatment, while there are no obvious differences prior and post treatment in control group, what's more, the change of NIHSS scores' variation is distinguished between two groups post treatment. The effective power of therapeutic group is 100%, while it is only 60% in control group. CBFs of maximum plane of infarction region, anterior border zone (ABZ), posterior border zone (PBZ) and white matter in injured sides of therapeutic group have improved to different extents compared post-treatment with prior treatment, while there is no significant difference in the homologue regions of injured sides in control group between prior and post treatment; The CBFs of hemisphere, maximum plane of infarction region, gray matter, ABZ, PBZ and white matter in uninjured side of both therapeutic and control groups have no distinguished changes. In therapeutic group, the CBFs of hemisphere and gray matter in both injured and uninjured sides have no significant change comparing post-treatment with prior treatment; while the CBFs of maximum plane of infarction region, ABZ, PBZ and white matter in injured side post-treatment improve to different extents compared with prior treatment and the CBF of the homologue regions in uninjured side has no distinguished change.From the results all above, we can know:①The improvement degree of neurological function in therapeutic group is much higher than that in control group, and the advancements of clinical symptoms in therapeutic group are better than that in control group. It suggests that NBP can improve neurologic impairment of patients with acute cerebral infarction and promote the recoveries of neurological functions.②The CBFs of hemisphere in injured side of both therapy and control groups decrease to different extents according to Xe-CT prior treatment. In therapy group, the CBFs of maximum plane of infarction region in injured side have obviously improved post-treatment, while the CBF of maximum plane of infarction region changes without predominance. Meanwhile, the CBFs of maximum plane of infarction region in both injured and uninjured sides in control group have no significant change. It suggests that NBP can increase CBF of ischemic brain tissue and its peripheral zones.③The CBFs of gray matter of therapy group and cortex, ABZ and PBZ of control groups in injured side post-treatment change insignificantly, while the CBFs of ABZ and PBZ in injured side of therapy group improve to different extents comparing post-treatment with prior treatment. We presume that NBP may increase regional CBF through promoting the open of ramus anastomoticus of cerebral pia mater surrounding the infarction focus, furthermore, NBP can improve neurological impairment.④In therapy group, the CBF of white matter in injured side post-treatment is much higher than that prior treatment. While the CBF of white matter in uninjured side of therapy group and the homologue regions of control group has no similar change. Thus we presume that NBP may improve collateral circulation and increase CBF of the infarction focus and its peripheral zones throught VEGF promoting angiogenesis around the infarction focus, however, this point needs furthermore verification.⑤On the 14^th day, the blood pressures of patients in both therapy and control groups are lower or stay the same level comparing with prior treatment, but without increasing. Patients in both groups have no respiratory dysfunction, acid-base imbalance and electrolyte disturbance. Thinking of the situation above, we could exclude the influence of blood pressure, partial pressure of oxygen, partial pressure of carbondioxide and power of hydrogen to CBF.Therefore, we can draw the conclusion that NBP can increase CBF of ischemic regions and their peripheries, improve the neurological impairment of acute cerebral infarction patients significantly and promote the recovery of neurologic function. We also can conclude that Xe-CT is useful to judge the recovery of patients with cerebral infarction and to observe and evaluate the curative effect of drugs.