依达拉奉注射液治疗颅内动脉瘤夹闭术后早期脑缺血患者的临床研究

Clinical trial of edaravone injection on patients with early cerebral ischemia after clipping of intracranial aneurysm

目的观察依达拉奉注射液对颅内动脉瘤夹闭术后早期脑缺血(ECI)患者的影响。方法 78例颅内动脉瘤夹闭术后早期脑缺血患者随机分为对照组39例和试验组39例。2组均给予高血容量、高灌注压、高血液稀释度等常规治疗。对照组静脉滴注等量的0.9%Na Cl;试验组在此基础上静脉滴注依达拉奉注射液30 g,加入0.9%Na Cl 100 m L中,30 min内滴注完毕,每日2次。2组均治疗14 d。比较2组患者的神经功能恢复情况及预后情况。结果治疗后,试验组和对照组的神经功能缺损程度评分(NFD)分别为(7.36±5.42),(10.71±4.39)分;Barthel评分分别为(49.20±13.32),(37.58±11.46)分,差异均有统计学意义(P<0.05)。治疗后,试验组和对照组的大脑中动脉血流速度分别为(95.38±19.60),(118.25±17.94)cm·s^(- 1);脑血管痉挛(CVS)发生率分别为12.82%(5/39例),33.33%(13/39例),差异均有统计学意义(P<0.05)。试验组格拉斯哥预后评分(GOS)5分的比例为79.49%(31/39例),对照组为58.97%(23/39例),差异有统计学意义(P<0.05)。治疗后,试验组血清超氧化物歧化酶(SOD)、一氧化氮(NO)和丙二醛(MDA)分别为(93.26±13.71)U·m L^(-1),(5.29±0.53)nmol·m L^(-1),(63.29±10.58)mol·L^(-1);脑脊液SOD、NO、MDA分别为(61.34±4.26)U·m L^(-1),(4.40±0.25)nmol·m L^(-1),(1.83±0.37)mol·L^(-1)。对照组血清SOD、NO、MDA分别为(80.20±11.59)U·m L^(-1),(6.74±0.32)nmol·m L^(-1),(50.91±9.37)mol·L^(-1),脑脊液SOD、NO、MDA分别为(54.29±6.64)U·m L^(-1),(5.12±0.83)nmol·m L^(-1),(1.50±0.24)mol·L^(-1)。试验组与对照组比较,差异均有统计学意义(P<0.05)。2组治疗期间均未见明显药物不良反应发生。结论依达拉奉注射液对血清及脑脊液氧自由基的清除作用,能够显著降低颅内动脉瘤夹闭术后早期脑缺血患者CVS发生率。

Objective To evaluate the clinical effect of edaravone injection on patients with early cerebral ischemia（ ECI） after clipping of intracranial aneurysm. Methods Seventy- eight patients with intracranial aneurysms were randomly divided into control group and treatment group,with 39 cases in each group. Patients in two groups were given the treatments of high blood volume,high perfusion pressure,blood dilution and others. On the basis of control group,treatment group was intravenously dripped edaravone 30 g mixed in 0. 9% Na Cl 100 m L,finished within 30 min. Control group was intravenously dripped 0. 9% Na Cl 100 m L. The treatment was lasted for 14 d. The neurological function recovery andprognosis of two groups were compared. Results After treatment,the neurologic function defect（ NFD） scores in treatment and control groups were（ 7. 36 ± 5. 42）,（ 10. 71 ± 4. 39） points（ P〈0. 05）. Barthel scores in treatment and control groups were（ 49. 20 ± 13. 32）,（ 37. 58 ± 11. 46） points（ P〈0. 05）. The blood flow velocity in brain and incidence of cerebral vasospasm（ CVS） in treatment group were（ 95. 38 ± 19. 60） cm·s^-1,12. 82%（ 5 /39 cases）. In control group,blood flow velocity in brain and incidence of CVS were（ 118. 25 ± 17. 94） cm·s^-1,33. 33%（ 13 /39cases）. There was significant difference between the two groups（ P〈0. 05）. The Glasgow outcome score（ GOS） of 5points in treatment group was 79. 49%（ 31 /39 cases）,had significant difference with that in control group,which was58. 97%（ 23 /39 cases,P〈0. 05）. Serum super oxide dismutase（ SOD）,nitric oxide（ NO） and malonaldehyde（ MDA） in treatment group were（ 93. 26 ± 13. 71） U·m L^-1,（ 5. 29 ± 0. 53） nmol·m L^-1and（ 63. 29 ± 10. 58）mol·L^-1after treatment. Cerebrospinal fluid SOD,NO and MDA in treatment group were（ 61. 34 ± 4. 26） U·m L^-1,（ 4. 40 ± 0. 25） nmol·m L^-1and（ 1. 83 ± 0. 37） mol · L^-1after treatment. Serum SOD,NO and MDA in control group were（ 80. 20 ± 11. 59） U·m L^-1,（ 6. 74 ± 0. 32） nmol·m L^-1and（ 50. 91 ± 9. 37） mol·L^-1after treatment.Cerebrospinal fluid SOD, NO and MDA in control group were（ 54. 29 ± 6. 64） U · m L^-1,（ 5. 12 ± 0. 83）nmol·m L^-1and（ 1. 50 ± 0. 24） mol ·L^-1after treatment. There was significant difference between the two groups（ P〈0. 05）. There were no obvious adverse drug reactions in two groups. Conclusion The scavenging effect of edaravone on oxygen free radical in serum and cerebrospinal fluid could significantly reduce cerebral artery blood flow and CVS incidence in patients with ECI after clipping of intracranial aneurysm.