纳美芬对高血压伴脑肿瘤患者术后血压及预后的影响

Effects of nalmefene on blood pressure and prognoses after surgery in hypertensive patients with intracranial turmors

目的探讨纳美芬对高血压伴脑肿瘤患者术后血压及预后的影响。方法 185例高血压伴脑肿瘤病人根据术前血压控制情况分为平稳控制组(98例)和非平稳控制组(87例)。按照投掷硬币法随机将两组又分为纳美芬治疗组(稳压治疗组52例,非稳压治疗组42例)与对照组(稳压对照组46例,非稳压对照组45例),前者在常规治疗基础上加用纳美芬治疗6d,后者术后常规治疗。所有患者常规监测血压,在术后检测患者血清皮质醇(COR)、促肾上腺皮质激素(ACTH)水平,术后第3、5、7、14、60天进行GCS评估。结果纳美芬治疗组的患者血清COR在治疗后4、6d显著低于对照组(P<0.05),治疗后2、4、6dACTH显著低于对照组(P<0.05),患者意识改善状况在术后一周明显优于对照组(P<0.05)。非稳压治疗组血压控制有效率明显高于非稳压对照组(P<0.01)。结论高血压伴脑肿瘤患者术后使用纳美芬能显著改善应激状态、血压与预后。

Objective To explore the effect of nalmefene on blood pressure and prognoses after the surgery in the hypertensive patients with intracranial tumors. Methods One hundred and eighty-five hypertensive patients with intraeranial tumors were randomly divided into blood pressure control （BPC） group （98 cases） and blood pressure non-control （BPNC） group （87 cases） according to the preoperative blood pressure control situation. Ninety-eight patients in BPC group and 87 patients in BPNC group were divided again into nalmefene treatment group and control （conventional treatment） group after the surgery. The serum levels of cortisol （COR） and adrenocorticotrophic hormone （ACTH） were determined 2, 4 and 6 days after treatment in all the patients, in whom GCS was determined 3, 5, 7, 14 and 60 days after the treatment and the blood pressure was continuously monitored for 5 days. Results The serum levels of COR were significantly lower in both the treatment groups respectively than those in both the control groups 4 and 6 days after the treatment （P〈0.05）. The serum levels of ACTH were significantly lower in both the treatment groups respectively than those in both the control groups （P〈0.05） 2, 4 and 6 days after the treatment. The consciousness was more significantly improved 7 after the treatment in both the treatment groups compared to that in both the control groups （P〈0.05）. The improvement of blood pressure was significantly better in the treatment BPNC group than that in the control BPNC group （P〈0.05）. Conclusions The serum levels of COR and ACTH increased in different degrees after the surgery for the intracranial tumors in the hypertensicve patietns. The stress situation, blood pressure and prognoses may be improved by nalmefene in the hypertensive patients with intracranial tumors undergoing craniotomy.