Influence Of Dl-3-n-butylphthalide On Cerebrovascular Carbon Dioxide Reactivity In Patients With Acute Middle Cerebral Artery Infarction

Objective: To observe the influence of dl-3-n-butylphthalide on outcome and cerebral carbon dioxide reactivity in patients with acute middle cerebral artery infarction.Methods:Totally 183 acute stroke patients within 7 days of stroke onset were investigated.Among of them,128 LAA patients and 55 SAO patients were included.The patients were randomly divided into 2 groups,100 patients in treatment group and 83 patients in the control group.All patients received the oral drugs for ischemic cerebrovascular disease that met the guideline criteria,and dl-3-n-butylphthalide 100 ml,2 times a day intravenously for 14 days was added in the treatment group.Patients in the treatment group received the oral drugs for 3 month.The CVR was evaluated by Tran cranial Doppler and CO₂ inhalation test,and reexamined 14 days and three month after treatment.The clinical status and disability were assessed by means of the National Institutes of Health Stroke Scale respectively.The mean velocity of MCA and CVR and the NIHSS score were recorded and then analyzed offline.SPSS 13.0 was administered to make a statistical analysis.Differences were considered statistically significant when the level of confidence exceeded 95%.Results: 1.A total of 183 patients met the inclusion criteria and were included in the analysis.In between,there were 102 patients in dl-3-n-butylphthalide group and 81 patients in the control group.All the enrolled patients finished the visit of 14 days.Only 40 patients finished the visit of 3 month,including 24 patients in the trial group and 16 patients in the control group.There was no significant difference about baseline state between the two groups?P>0.05?.2.The NIHSS score and CO₂ R were improved in both the trial group and the control group after intervention for 14 days,the difference was statistically significant?P<0.001?.The Vm of MCA were decreased after intervention,the difference was statistically significant?P=0.006?.The Vm of MCA had a decreasing tendency in the control group,but the change was no statistical significance?P=0.873?.The NIHSS score and CO₂ R were improved in both the trial group and the control group after intervention for 3 month,the difference was statistically significant?P<0.05?.The Vm of MCA had a decreasing tendency in the control group and the trial group,but the change was no statistical significance?P>0.05?.3.The degrees of changes of CO₂ R and NIHSS score for both 14 days and 3 month were improved after the dl-3-n-butylphthalide treatment than in the control group,the difference was statistically significant.?t=2.24,P=0.026;t=2.959,P=0.004??Z=-2.373,P=0.018;Z=-2.241,P=0.025?.But there was no remarkable difference of the changes of MCA Vm in the trial group than in the control group.?t=-1.967,P=0.051;Z=-1.864,P=0.062?.4.There was remarkable difference of the change of CO₂ R after dl-3-n-butylphthalide intervention after 14 days in both LAA and SAO patients comparison with the baseline state?t=-7.341,P<0.001;t=-2.452,P=0.022?.In the control group,there was remarkable difference of the change of CO₂ R in LAA patients compared with the baseline state?t=-3.866,P<0.001?.But in SAO patients in the control group,there was no difference?t=-0.42,P=0.678?.In LAA patients,the degrees of changes of CO₂ R were more obvious in the trial group than in the control group,the difference was statistically significant?t=2.144,P=0.034?.While in SAO patients,there was no remarkable difference?t=1.667,P=0.101?.There was remarkable difference of the change of NIHSS score after dl-3-n-butylphthalide intervention after 14 days in both LAA and SAO patients in comparison with the baseline state?t=10.299,P<0.001;t=5.413,P<0.001?.In the control group,there was remarkable difference of the change of NIHSS score in LAA and SAO patients compared with the baseline state?t=7.964,P<0.001;t=6.601,P<0.001?.In both LAA and SAO patients,there was no remarkable difference in the degrees of changes of NIHSS score when compared between the trial group and the control group?t=-1.396,P=0.165;t=-1.661,P=0.105?.The MCA Vm of LAA patients in the trial group were decreased after intervention for 14 days,the difference was statistically significant?t=3.423,P=0.001?.The MCA Vm of SAO patients in the trial group had an increasing tendency after intervention,but the change was no statistical significance?t =0.487,P=0.631?.There was no remarkable difference of the MCA Vm in both LAA and SAO patients in the control group when compared with the baseline state.?t=-0.235,P=0.815;t=0.028,P=0.978?.Conclusion:1.Dl-3-n-butylphthalide can increase the CO₂ R of acute ischemic stroke patients in MCA territory and improve clinical prognosis of 14 days and 3month.2.Dl-3-n-butylphthalide decreases the mean Vm of MCA in LAA patients,which indicates that it can decrease pressure load of the damaged MCA and it may also a result of collaterals opening.3.There is a more remarkable effective of Dl-3-n-butylphthalide on LAA patients than that of SAO in improving cerebral reserve capacity.