前列地尔注射液联合尼莫地平注射液治疗动脉瘤性蛛网膜下腔出血伴脑血管痉挛的临床研究

发布时间：2018-02-25 05:16

本文关键词： 前列地尔尼莫地平蛛网膜下腔出血脑血管痉挛血管内皮炎症因子认知功能　出处：《中国临床药理学杂志》2016年21期 　论文类型：期刊论文

【摘要】：目的观察前列地尔注射液联合尼莫地平注射液对动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者血管内皮、炎症因子及认知功能的影响。方法 85例动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者按照随机数字表法分为对照组42例和试验组43例。对照组在常规治疗基础上静脉滴注前列地尔注射液10μg,加入0.9%Na Cl 100 m L,每天1次;试验组在对照组的基础上静脉滴注尼莫地平注射液50 m L,加入0.9%Na Cl 250 m L,每天1次。2组均治疗14 d。治疗后,观察2组患者的临床疗效,测定患者血浆降钙素基因相关肽(CGRP)和内皮素-1(ET-1)的含量,检测血清血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)及超敏C反应蛋白(hs-CRP)水平,用蒙特利尔认知评估量表(MOCA)评估认知功能。结果试验组的总有效率为90.70%(39/43例),对照组的总有效率为73.81%(31/42例,P0.05)。试验组CGRP为(55.56±8.44)pg·m L~(-1),VEGF为(123.35±34.83)ng·m L~(-1);对照组CGRP为(47.29±8.49)pg·m L~(-1),VEGF为(142.38±14.47)ng·m L~(-1)(P0.05)。试验组ET-1为(71.35±10.46)pg·m L~(-1),对照组ET-1为(91.81±11.70)pg·m L~(-1),2组差异有统计学意义(P0.05)。试验组TNF-α为(0.24±0.08)ng·m L~(-1),IL-8为(1.39±0.31)ng·m L~(-1),hs-CRP为(189.51±23.27)ng·m L~(-1);对照组TNF-α为(0.32±0.10)ng·m L~(-1),IL-8为(2.24±0.34)ng·m L~(-1),hs-CRP为(211.51±25.51)ng·m L~(-1),2组差异有统计学意义(P0.05)。2组药物不良反应主要为胃肠道反应、恶心呕吐、头晕头痛、皮疹,试验组药物不良反应发生率为25.58%(11/43例),对照组为26.19%(11/42例),差异无统计学意义(P0.05)。结论前列地尔联合尼莫地平可改善动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者血管内皮功能,降低炎症反应,增强认知功能,有良好的临床疗效。
[Abstract]:Objective to observe the effect of alprostadil injection combined with nimodipine injection on vascular endothelium in patients with aneurysm subarachnoid hemorrhage and cerebral vasospasm. Methods Eighty-five patients with aneurysm subarachnoid hemorrhage associated with cerebral vasospasm were randomly divided into control group (n = 42) and experimental group (n = 43). Alprostadil injection 10 渭 g was injected intravenously with 0.9% NaCl 100ml, once a day. On the basis of the control group, the experimental group was given nimodipine injection 50 mL by intravenous drip, and 0.9 NaCl 250 mL was added to the experimental group. The treatment of group 2 was done once a day for 14 days. After treatment, the clinical efficacy of the two groups was observed. The plasma levels of calcitonin gene-related peptide (CGRP) and endothelin-1 (ET-1) were measured. The levels of serum vascular endothelial growth factor (VEGF), tumor necrosis factor- 伪 (TNF- 伪), interleukin-8 (IL-8) and hypersensitive C-reactive protein (hs-CRP) were measured. Results the total effective rate was 90.70% 39 / 43 cases in the trial group and 73.81% in 42 cases in the control group (P 0.05). The CGRP in the trial group was 55.56 卤8.44 ng 路mL -1 CGRP was 123.35 卤34.83 ng 路mL ~ (-1), the CGRP in the control group was 47.29 卤8.49 PG 路m ~ (-1) CGRP was 142.38 卤14.47 ng 路mL ~ (-1). The ET-1 in the trial group was 142.38 卤14.47 ng 路mL ~ (-1). TNF- 伪 was 0.24 卤0.08 ng 路mL -1 IL-8, 1.39 卤0.31 ng 路mL -1 IL-8, 189.51 卤23.27 ng 路mL -1 in control group, 0.32 卤0.10 ng 路mL ~ (-1) in control group, 2.24 卤0.34 ng 路mL ~ (-1) in TNF- 伪 and 11.251 卤25.51 ng 路L ~ (-1) L ~ (-1) CRP in the control group, respectively. There were significant differences in the adverse reactions of stomach and stomach in the control group (TNF- 伪 = 0.32 卤0.10 ng 路m ~ (-1)). The level of IL-8 was 2.24 卤0.34 ng 路mL ~ (-1) in the trial group, and the significant difference was (11.251 卤25.51) ng 路m ~ (-1) L ~ (-1) in the gastric side effects in the control group (P < 0.05), and in the control group, the TNF- 伪 was 0.32 卤0.10 ng 路m ~ (-1). The level of IL-8 in the intestinal tract was 2.24 卤0.34 ng 路m ~ (-1). Nausea, vomiting, dizziness, headache, rash, The incidence of adverse drug reactions in the trial group was 25.58 / 11 / 43, while in the control group was 26.19 / 11 / 42, with no significant difference (P 0.05). Conclusion alprostadil combined with nimodipine can improve vascular endothelial function in patients with aneurysm subarachnoid hemorrhage and cerebral vasospasm. Reduce inflammatory reaction, enhance cognitive function, has good clinical efficacy.
【作者单位】：嘉兴市第二医院神经外科;浙江大学附属第二医院神经外科;
【分类号】：R743.35

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