吡拉西坦联合甘露醇治疗脑出血患者脑水肿的效果观察

Clinical efficacy observation of piracetam combined with mannitol in the treatment of cerebral edema after intracerebral hemorrhage

目的观察吡拉西坦联合甘露醇治疗脑出血后脑水肿的临床疗效。方法选取医院2013年6月-2017年1月收治的脑出血患者65例作为研究对象,将其随机分为观察组(33例)和对照组(32例)。观察组给予吡拉西坦联合甘露醇治疗,对照组给予甘露醇,采用美国国立卫生研究院脑卒中量表(NIHSS)、头颅CT、双抗体夹心法分别在入院时、入院后第8天、第20天时评估和检测2组患者神经功能缺损评分、脑水肿体积、血清水通道蛋白4(AQP4)水平。结果入院时,2组NIHSS评分、脑水肿体积及AQP4水平比较差异无统计学意义(P>0.05)。治疗8 d及治疗20 d时,2组NIHSS评分、脑水肿体积及AQP4水平均较入院时降低,且治疗20 d时2组NIHSS评分、脑水肿体积及AQP4水平均较治疗8 d时低,差异均有统计学意义(P<0.05)。观察组的NIHSS评分、脑水肿体积及AQP4水平在治疗8 d和20 d时均低于对照组,差异均有统计学意义(P<0.05)。结论吡拉西坦联合甘露醇治疗脑出血后脑水肿能有效减轻脑水肿,降低颅内压,保护脑细胞,值得临床推广。

Objective To observe the clinical efficacy of piracetam combined with mannitol in the treatment of cerebral edema after intracerebral hemorrhage. Methods 65 cases of cerebral hemorrhage treated in the hospital in January-2017 June 2013 were selected as the research object. It was randomly divided into the observation group（ 33 cases） and the control group（ 32 cases）. The observation group was treated with piracetam combined with mannitol,and the control group was given mannitol. The National Institutes of Health Stroke Scale（ NIHSS）,head CT and double antibody sandwich method were used to evaluate and detect neurological deficit score,brain edema volume and serum aquaporin 4（ AQP4） level in two groups at admission,treatment of 8 days and treatment of 20 days respectively. Results At admission,there was no significant difference in NIHSS scores,the volume of brain edema and the level of AQP4 between the two groups of（ P〉0. 05）. After the 8 days＇ and the 20 days＇ treatment,NIHSS scores,the volume of brain edema and the level of AQP4 in the two groups were all lower than those at the time of admission,and above indicators in the two groups after treatment of 20 days were lower than after treatment of 8 days,and the differences were statistically significant（ P〈0. 05）. The NIHSS scores,volume of brain edema and the level of AQP4 in the observation group were lower than those in the control group at 8 days and 20 days,and the differences were statistically significant（ P〈0. 05）. Conclusion Piracetam combined with mannitol in the treatment of cerebral edema after intracerebral hemorrhage can effectively reduce brain edema,reduce intracranial pressure and protect brain cells,which is worthy of clinical promotion.