纳美芬对脑肿瘤术后患者血浆皮质醇、促肾上腺皮质激素及葡萄糖水平的影响

Effects of nalmefene on postoperative plasma cortisol,adrenocorticotropic hormone and glucose levels of patients with brain neoplasms

目的探讨脑肿瘤手术后纳美芬对患者血浆皮质醇、促肾上腺皮质激素(ACTH)、葡萄糖水平的影响。方法将185例接受手术治疗的脑肿瘤患者按治疗方案分为常规治疗组(n=90,术后采用常规治疗)及纳美芬治疗组(n=95,术后在常规治疗的基础上,静脉滴注纳美芬8μg·kg-1·d-1,持续6d)。选择同期入院尚未接受颅内手术的44例脑肿瘤患者作为对照组。纳美芬治疗第2天(d2)、第4天(d4)、第6天(d6)时检测患者血浆皮质醇、ACTH及葡萄糖浓度;术后第3、5、7、14、60天采用格拉斯哥昏迷量表(GCS)评分及Barthel指数评分进行神经功能评估,术后第90天采用卡氏身体功能状态(KPS)评分进行远期疗效评价。结果除外d6时间点,常规治疗组与纳美芬治疗组患者在其余时间点的血浆皮质醇、ACTH、葡萄糖浓度均明显高于对照组(P<0.05)。在d2、d4、d6时间点,纳美芬治疗组患者的血浆皮质醇、ACTH、葡萄糖浓度均显著低于常规治疗组(P<0.05)。以第3天GCS评分结果为基数,纳美芬治疗组患者累计意识等级上升情况明显优于常规治疗组(P<0.05)。纳美芬治疗组患者在术后第14天和术后第60天的神经功能的改善情况(Barthel指数评分)以及远期预后(KPS评分)均明显优于常规治疗组(P<0.05)。结论术后使用纳美芬可显著降低患者血浆皮质醇、ACTH、葡萄糖水平,明显改善患者预后。

Objective To investigate effects of nalmefene on postoperative plasma cortisol, adrenocorticotropic hormone （ACTH） and glucose levels of patients with brain neoplasms. Methods 185 patients with brain neoplasms who accepted surgical treatment were divided into conventional treatment group（n= 90, accepted conventional treatment after surgery） and nalmefene treatment group （n=95,administrated with nalmefene 8 μg · kg ^-1 · d^-1 by intravenous infusion for 6 days on the basis of conven tional treatment after surgery） according to therapeutic regimen. 44 patients with brain neoplasms hospitalized during the same period who had not yet accepted intracranial surgery were selected and served as control group. Plasma cortisol,ACTH and glucose concentration of patients were detected on day 2 （d2）, day 4 （ d4）, day 6 （d6） after nalmefene administration. Glasgow coma scale （GCS） scores and Barthel index scores were adopted to assess nerve function on day 3,day 5,day 7,day 17 and day 60 after surgery,and Karnofsky＇s performance status（KPS） scores were employed for evaluation of long term efficacy on day 90 after surgery. Results Except time point of d6,plasma cortisol,ACTH,glucose concentrations of patients in conventional treatment group and nalmefene treatment group were significantly higher than those in control group on the rest of time points（P〈0.05）. On d2, d4 and d6, plasma cortisol, ACTH, glucose concentrations of patients in nalmefene treatment group were markedly lower than those in conventional treatment group（P〈0.05）. Taking GCS score value on day 3 as the base, cumulative rises of consciousness level of patients in nalmefene treatment group were significantly superior to those in conventional treatment group（P〈0.05）. Nerve function improvement（Barthel index score） on day 4 and day 6 after surgery as well as long-term prognosis（KPS score） on day 90 of patients in nalmefene treatment group were obviously superior to those in conventional treatment group（P〈0.05）. Conclusion Postoperative administration of nalmefene can significantly decrease levels of plasma cortisol, ACTH, glucose, and markedly improve prognosis of patients.