吡拉西坦注射液联合甘露醇治疗脑出血脑水肿的临床研究

Clinical Study of Effect of Piracetam Injection Combined with Mannitol on Encephaledema in Patients with Intracranial Haemorrhage

目的观察吡拉西坦注射液联合甘露醇治疗脑出血脑水肿的临床效果及安全性。方法将我院近1年多来收治的65例脑出血患者,随机分为治疗组和对照组,出血量在15～40ml之间,两组的基础治疗用药神经保护剂相同,治疗组33例应用20%吡拉西坦注射液100ml静脉滴注,2次/天,连续应用10天,同时应用20%甘露醇125ml静脉滴注,q12h/q8h;对照组32例,应用20%甘露醇125ml静脉滴注,q8h/q6h,连续应用10天;每天观察患者用药后头痛、视乳头水肿及意识状况的改变,采用全国第4届脑血管病会议神经功能缺损程度(SSS)评分判定临床疗效。同时检测用药前及用药后24h的尿量及尿比重变化。在用药后15天时复查颅脑CT观察血肿的体积以及血肿周围脑水肿的变化。结果两组患者主要临床症状如头痛、呕吐、视乳头状态及意识障碍等较给药前均有改善,治疗后15天时治疗组症状显效率为67%(22/33),对照组为56%(18/32),两组间有显著性统计学差异(P=0.038);治疗组用药后24h平均尿量为(3644.5±210.4)m1,对照组患者用药后24h的尿量为(3341.9±205.3)ml,两组间具有显著性统计学差异(P<0.05);治疗组用药后平均尿比重为(1.013±0.027),对照组用药后平均尿比重为(1.019±0.030),两组间无显著性统计学差异。治疗15天时CT显示治疗组血肿体积减少(9.9±3.3)ml,水肿平均缩小面积(18.3±2.3)cm2,对照组血肿体积减少(8.0±2.8)ml,水肿平均缩小面积(15.1±2.0)cm2,两组间有显著性统计学差异(P<0.05)。治疗组患者未出现血尿、失眠、兴奋及脏器功能损害等情况。结论吡拉西坦注射液联合甘露醇治疗脑出血继发的脑水肿优于单纯应用甘露醇,并且安全性好。

Objective To investigate the effect ofpiracetam injection combined with mannitol on reduction the encephaledema in patients with intracranial haemorrhage. Methods 65 patients with intracranial haemorrhage in our hospital were divided into the treatment group and the control group, the bleed volumes were 15 - 40 ml. The basic treatment drugs were the same in both groups. 33 cases in the treatment group were injected by the 20% piracetam injection 100 ml bid for 10 days, and at the same time 20% mannitol 125 ml were used q 12 h or q 8 h. 20% mannitol 125 ml was used q8h or q6h only in the control group. Everyday we observed the clinical manifestations including headach, papiUedema and consciousness. The urine volumes and specific gravity urine were measured before treatment and 24 h post-treatment, respectively. At 15 days after treatment, cranial CT scan was used to survey the volumes of hematomas and encephaledema. Results Although the clinical manifestations were relieved in both groups, the effective rate in the treatment group was statistically significant compared to the control group. The urine volumes of treatment group increased significantly compared to the control group. There was no statistically significant difference in the variation of the specific gravity urine between the two groups. The volumes of hematomas and encephaledema reduced by （9.9 ± 3.3） ml and （18.3± 2.3） cm^2 in the treatment group, respectively. The reductions of volumes were statistically significant compared to the control group. There were no blood urine, insomnia, exciting and lesion of organ functions. Conlusion Piracetam injection combined with mannitol is superior to mannitol for the treatment of encephaledema in patients with intracranial haemorrhage, and the treatment is safe.