天麻素注射液对减轻神经介入血管内操作血管痉挛的临床研究

Effect of Gastrodin Injection on Cerebral Vasospasm caused by Endovascular Intervention

目的:通过观察神经介入血管内操作患者血浆NO、ET-1含量的动态变化及左侧大脑中动脉、右侧大脑中动脉、基底动脉平均流速(Vm)及搏动指数(PI)的改变,评估天麻素注射液对减轻神经介入血管内操作脑血管痉挛(CVS)的临床疗效。方法:选取我院进行神经介入血管内操作(即神经介入手术)患者共80例,随机分为对照组(术前单用尼莫地平注射液组)、治疗组(天麻素注射液联合尼莫地平注射液组)各40例。采用ELISA法分别在术前1 d及术后1、3 d测定血浆一氧化氮(NO)、内皮素-1(ET-1)含量,同时在相同时间点行经颅多普勒超声(TCD)检查观察左侧大脑中动脉、右侧大脑中动脉、基底动脉平均流速(Vm)及搏动指数(PI)。结果:神经介入血管内操作后,治疗组及对照组一氧化氮(NO)、内皮素-1(ET-1)水平均有改变,差异均有统计学意义(P<0.05);治疗组较对照组一氧化氮(NO)值升高更明显,而内皮素-1(ET-1)值下降更明显,差异有统计学意义(P<0.05)。在不同时间点检测左侧大脑中动脉、右侧大脑中动脉、基底动脉平均流速(Vm)及搏动指数(PI)值,治疗组较对照组降低明显,差异有统计学意义(P<0.05)。结论:神经介入血管内操作中,天麻素注射液通过升高血浆一氧化氮(NO)水平,降低内皮素-1(ET-1)水平,具有保护血管内皮,改善脑血管血流动力学的作用。

Objective： To observe the dynamic changes of NO and ET-I levels in plasma and the change of vascular hemodynamics before and after the endovascular intervention, and to prove the efficacy of Gastrodin Injection in alleviating the cerebral vasospasm after endovascular intervention. Methods： The 80 patients with in- tervention treatment operation in our hospital were randomly divided into the control group and the observation group, 40 cases in each group. The control group, injected Nimodipine by intravenous drip. The observation group injected Nimodipine combined with gastrodin. The level of nitric oxide （NO） and endothelin-1 （ET-1） in plasma of each group was measured by Enzyme linked immunosorbent assay （ELISA） method before and after endovascular intervention in 1 and 3 days. Then each case had hemodynamics evaluation with TCD lday before endovascular intervention and after the intervention in 1 and 3 days. The mean velocity （Vm） of middle cere- brum, basilar artery and pulsatility index （PI） were measured. Results： After endovascular intervention, the level of NO and ET-1 significantly changed both in the control group and the observation group （P〈0.05）. The level of NO increased higher while the level of ET-1 decreased lower in the observation group than the control group, both were statistically significant （P〈0.05）. The mean velocity （Vm） and pulsatility index （PI） of middle- cerebrum, basilar artery at different times were significantly decreased when compared with the control group （P〈 0.05）. Conclusion： Gastrodin played a role in protecting vascular endothelial ceils and improving hemodynamics in endovascular intervention by raising the level of plasma nitric oxide （NO）, reducing the level of endothelin -1 （ET-1）.