前列地尔联合格拉司琼治疗小脑梗塞后眩晕的疗效评价

Clinical effect of lipo-prostaglandin E1 combined with granisetron for dizziness caused by cerebellar infarction

目的观察前列地尔联合格拉司琼治疗小脑梗塞后患者体位改变、闭目站立、视物旋转及呕吐等眩晕症状的临床疗效。方法采用病例对照研究方法,对符合入选标准的32例小脑梗塞后眩晕患者,每天给予静脉滴注前列地尔20μg和格拉司琼6 mg,连续14 d,采用Berg平衡量表和改良Barthel指数评分量表评定临床疗效,分别于治疗前和治疗后连续3 d观察评分,取平均分数,测量所有指标时间均在每天上午8:00—10:00之间;采用自身对照t检验分析治疗前后差值的平均数和标准差。结果 32例小脑梗塞后眩晕患者治疗前后Berg和Barthel评分平均数分别为10.6±3.4、16.14±10.01和45.80±6.75、60.62±11.53;治疗前后差值平均数分别为34.81±5.05和44.17±9.98,经t检验(P<0.01),差异存在统计学意义;32例小脑梗塞患者临床眩晕症状完全消失11例,显著好转18例,好转3例。结论前列地尔联合格拉司琼能非常有效地治疗小脑梗塞后眩晕,不良反应少且轻微,具有良好的耐受性,可推荐作为治疗小脑梗塞后眩晕方案之一。其机制可能是前列地尔能够扩张颅内痉挛血管增加侧支循环,抑制血小板的聚集防止血栓形,增加红细胞的变形能力使之能通过毛细血管有效改善微循环;同时格拉司琼能阻断眩晕经由5-HT3受体激活迷走神经的传入支而触发的呕吐反射,两者协同作用,从而改善眩晕和呕吐症状。

Objective To explore the clinical effect of lipo-prostaglandin E1 combined with granisetron in the treatment of the vertigo, unsteady gait, dizziness, nausea and vomiting caused by cerebellar infarction. Methods A case control study was performed among 32 patients with dizziness caused by cerebellar infarction meeting the diagnosis criteria. The patients received the intravenous drip of 20 μg lipo-prostaglandin E1 and 6mg granisetron for 14 days. The clinical efficacy was as- sessed at 8 - 10 a. m everyday by using Berg Balance Scale（BBS） and improved Barthel before and after the treatment for three consecutive days. The paired T-test was used for the statistical analysis. Results The BBS scale before and after the treatment were 10.6 ± 3.4 and 45.8 ± 6.75, and the difference in mean was 34.81 ± 5.05 （P 〈 0.01 ） ;Barthel scale were 16.14 ± 10.01 and 60.62 ± 11.53 ,and the difference in mean was 44.17 ±9.98（P 〈0.01 ）. The symptoms of dizziness disappeared in cases,remarkable improved in 18 cases and improved in 3 cases. Conclusion The effects of Lipo-prosta- glandin E1 combined with granisetron is effective in the treatment of dizziness caused by Cerebellar infarction with less side effects and well-tolerated,which is an ideal plan for dizziness caused by Cerebellar infarction. The mechanism may be that alprostadil can dilate intracranial vasospasm, increase collateral circulation, inhibit platelet aggregation, prevent from thrombosis, increase the deformability of erythrocyte which makes it easy pass the capillaries and effectively improve mi- crocircuiation ; granisetron can block the afferent vertigo via 5-HT3 receptor activation of vagal and trigger the vomiting re- flex, synergy, and improve vertigo and vomiting.