依达拉奉联合尼莫地平对急性脑梗死患者神经功能与炎性因子水平的影响观察

Effect of edaravone combined with nimodipine on neurological function and inflammatory factors in the patients with acute cerebral infarction

目的探讨依达拉奉联合尼莫地平治疗急性脑梗死患者疗效及其对神经功能与炎性因子水平的影响.方法选取海口市人民医院2015年2月至2017年12月收治的156例急性脑梗死患者,随机分为对照组、尼莫地平组与联合组(每组各52例).对照组采取常规内科治疗,尼莫地平组在对照组治疗基础上联合尼莫地平,联合组在尼莫地平组治疗基础上联合依达拉奉,每组疗程均14 d.比较三组总有效率及治疗前、治疗7 d、治疗14 d血清高敏C-反应蛋白(hs-CRP)、五聚素3(PTX3)、脂蛋白相关磷脂酶A2(Lp-PLA2)、胰岛素样生长因子-1(IGF-1)及神经元特异性烯醇化酶(NSE)水平.治疗完成后随访3个月,记录三组治疗前、治疗7 d、治疗14 d、治疗后1个月、治疗后2个月、治疗后3个月美国国立卫生研究院卒中量表(NIHSS)评分与日常生活能力量表(ADL)评分并比较.统计三组治疗期间不良反应总发生率.结果对照组、尼莫地平组与联合组的总有效率分别为72.55%、88.46%与94.00%,尼莫地平组与联合组总有效率均明显高于对照组(P<0.05).三组患者治疗7 d和14 d血清hs-CRP、PTX3、Lp-PLA2及NSE与治疗前比较均明显下降,IGF-1较治疗前升高(P<0.05).治疗后7 d和14 d,尼莫地平组血清hs-CRP、PTX3、Lp-PLA2及NSE分别为(20.85±3.97)mg/L和(8.15±1.62)mg/L、(3.72±0.71)ng/L和(2.54±0.47)ng/L、(10.53±1.75)μg/L和(7.30±1.48)μg/L、(33.39±3.99)ng/L和(18.41±2.95)ng/L,联合组分别为(18.76±3.88)mg/L和(7.11±1.44)mg/L、(3.37±0.63)ng/L和(2.26±0.42)ng/L、(9.71±1.67)μg/L和(6.89±1.33)μg/L、(31.62±4.42)ng/L和(14.08±2.83)ng/L,两组均明显低于对照组,同时联合组也明显低于尼莫地平组(P<0.05).尼莫地平组治疗后7 d和14 d血清IGF-1分别为(122.81±15.86)ng/mL和(155.17±19.95)ng/mL,联合组分别为(144.83±17.69)ng/mL和(171.09±23.06)ng/mL,两组均明显高于对照组,同时联合组高于尼莫地平组(P<0.05).随访至治疗后3个月,三组NIHSS评分均明显下降、ADL评分明显升高(P<0.05).联合组随访结束时NIHSS评分为(76.11±3.01)分,明显高于尼莫地平组与对照组[(68.21±3.45)分和(60.22±4.11)分],同时尼莫地平组明显高于对照组(P<0.05).三组治疗期间不良反应总发生率分别为9.62%、15.38%与19.23%,差异无统计学意义(P>0.05).结论在常规内科治疗急性脑梗死基础上联合依达拉奉与尼莫地平可发挥协同作用,通过抑制脑细胞过氧化、清除氧自由基、减轻脑组织损伤等作用,有效地抑制炎症反应,减轻神经细胞与神经元损伤,为急性脑梗死患者神经功能的恢复创造有利条件,疗效好,安全性高,值得推广.

Objetive To investignte the efianey of eduravane combined with mimodipine in the teitment of neute erebral infaretin and its eferet oe neurlogical function and inflamntery factors in the patientse Methods A sotal of 156 patints with acute ceebal iefuretion adnited to our bospisal from February 2015 to December 2017 were randoemly divided into comtrol gmoup,nimodipine group and combinato group,52 cases in each group.The control group roceived conventioeal mrdical treatment.The mimodipine group Wa teated wih rimnodipipe on the basise of the contral group.and the coumbination goup wa telated with ederavone on the baais of the nidipine grop four 14 days.Toal eetie rale,senum bigh-senitiriy C-Teative proitein(hs-CRP),penamerie 3(PTX3).liprolein-ascinted pbospholipase A2(Ip-PLA2)of,imsulin growth factor-1(IGF-1)and neuron specifie enolase(NSE)lerels before treatment,7 days ater treatment,14 days after treatment were compared in the three goups.The NIHISS scores and the ADL seres of the three goups before treatment.7 days after treatment,14 days afher treament,1 month ater teatrent,2 moeths ater treatmenl,and 3 months after ratment wee reorded and coepared.The total ineidence of sadvese reacions during te treatnent periods was counted,Results The lotal efetite nites o the cotnol group,nindipine goup.and combination goup were 72.55%,88,46%,aund 94.00%,and the overall comprison was satititally siguificam(P<0.05).In the pairvise coumparion,the total efetre ralee of the nimedipine goup and the combinaion group were sigifcanly higher than thee of the control group(P<0.05).There was a stsitially sigificant diference in the elimieal ffiuory of the three grups(P<0.05),and the nimodipine group and the combination group were bter than the control group(P<0.05).The serum hs-CRP,PIX3,Lp-PLA2,and NSE af the three groups were sigificamly lomer tham befure treatment,and ICF-1 were higher than before treatment(P<0.05).At 7 days and 14 days after treatment,the seum hs-CRP,PTX3,Lp-PLA2,and NSE of the mnodipine group were(20.85±3.97)mg/L and(8.15±1.62)mg/L,(3.72±0.71)ng/L and(2.54±0.47)ng/L,(10.53±1.75)μg/L and(7.30±1.48)μg/L,(33.39±3.99)ng/L and(18.41±2.95)mg/L,the combinution goup were(18.76±3.88)mg/L and(7.11±1.44)mg/L,(3.37±0.63)ng/L and(2.26±0.42)ng/L.(9.71±1.67)ug/L and(6.891.33)ug/L.(31.62±4.42)ngL and(14.08±2.83)ng/L.buth groups were ignifceantly lorer than the ceitnal group,while the onbination group were alo sipifcanly lower than the nimdipipe grop(P<0.05).The serum ICF-I of the nimdipine group at 7 days and 14 days ather treatment were(122.81±15.86)ng/ml and(155.17±19.95)ng/mL,and the combination group were(144.83117.09)ng/mL and(171.09±23.06)ng/mL,both groups were sigificanly higher than he control group,while the combination group were hipher than the nimdipine goup(P<0.05).During fllow-up to 3 monthes after treatment,the NIHSS seomes of all three groups deereased sgifcantly and the ADL scores inceased sgificamly(P<0.05).The NIHISS score at the end of the fllw-up of the combination group mas(76.11±3.01)points.which Hae sigifcanly higher than the nindipine group and the control group[(68.21±3.45)polnts and(60.22±4.11)poits]。while the nimodipine group was sgnifiandy higher than contol group(P<0.05).The tolal ineidenre of adverse reactions in three goups were 9.62%,15.38%and 19.23%,and the difference was stitiscally sigifcan(P>0.05).Concdusion On the basis of covenional medical tesatment,edaravone and nimodipine can exert synergistic effects,inhibit inflammatory reaction and lesen nene cells and neuronal darmage by inibiting beain cell peroxidation,scavenging oxygen free rdicals,and lleriating brain tsue damage,creale favorable conditions for the reovery of neunlogical funetion in patieats with arcute erbral infaretion,with high effectiveness and safety,and is worth promting.