桂哌齐特联合法舒地尔治疗脑动脉瘤栓塞术后脑血管痉挛的临床研究

Clinical study on cinepazide combined with fasudil in treatment of cerebral vasospasm after cerebral aneurysm embolization

目的探讨桂哌齐特联合法舒地尔治疗脑动脉瘤栓塞术后的脑血管痉挛的临床疗效。方法选取2012年6月—2017年6月在大连大学附属中山医院治疗的脑动脉瘤栓塞术后脑血管痉挛的患者152例,随机分为对照组(76例)和治疗组(76例)。对照组静脉滴注盐酸法舒地尔注射液,30 mg加入100 m L生理盐水,3次/d。治疗组在对照组的基础上静脉滴注马来酸桂哌齐特注射液,320 mg加入10%葡萄糖溶液500 m L,2次/d。两组患者均治疗14 d。观察两组患者临床疗效,比较治疗前后两组患者NFI评分、Glasgow昏迷评分、Barthel指数评分、经颅多普勒(TCD)指标和血清学指标。结果治疗后,对照组的临床总有效率为80.26%,显著低于治疗组的94.74%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组NFI评分明显降低,Glasgow昏迷和Barthel指数评分明显升高,同组比较差异具有统计学意义(P<0.05);且治疗组NFI评分、Glasgow昏迷和Barthel指数评分比对照组改善更显著(P<0.05)。治疗后,两组双侧大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)血流速度均显著增加(P<0.05);且治疗组比对照组增加更显著(P<0.05)。治疗后,两组血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和内皮素-1(ET-1)水平显著降低,一氧化氮(NO)和6-酮-前列腺素F1α(6-K-PGF1α)水平显著升高,同组比较差异具有统计学意义(P<0.05);且治疗组血清学指标改善后水平明显优于对照组(P<0.05)。结论马来酸桂哌齐特联合法舒地尔治疗脑动脉瘤栓塞术后的脑血管痉挛可有效改善患者意识状态,抑制机体炎症细胞因子表达,增加脑血流速度,促进神经功能损伤修复。

Objective To investigate the clinical curative effect of cinepazide combined with fasudil in treatment of cerebral vasospasm after cerebral aneurysm embolization. Methods Patients（152 cases） with cerebral vasospasm after cerebral aneurysm embolization in Affiliated Zhongshan Hospital of Dalian University from June 2012 to June 2017 were randomly divided into control（76 cases） and treatment（76 cases） groups. Patients in the control group were iv administered with Fasudil Hydrochloride Injection, 30 mg added into normal saline 100 m L, three times daily. Patients in the treatment group were iv administered with Cinepazide Maleate Injection on the basis of the control group, 320 mg added into 5% glucose solution 500 m L, twice daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the NFI, Glasgow and Barthel scores, TCD indexes, and serological indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 80.26%, which was significantly lower than 94.74% in the treatment group, and there were differences between two groups（P〈0.05）. After treatment, the NFI scores in two groups were significantly decreased, but Glasgow and Barthel index scores were significantly increased, and the difference was statistically significant in the same group（P〈0.05）, and these scores in the treatment group were significantly better than those in the control group（P〈0.05）. After treatment, the blood flow rate of ACA, MCA, and PCA in two groups was significantly increased（P〈0.05）, and the blood flow rate in the treatment group was significantly better than that in the control group（P〈0.05）. After treatment, the hs-CRP, IL-6, TNF-α and ET-1 levels in two groups were significantly decreased, but NO and 6-K-PGF1α levels were significantly increased, there were differences in the same group（P〈0.05）, and the serological indexes in the treatment group were significantly better than those in the control group（P〈0.05）. Conclusion Cinepazide combined with fasudil in treatment of cerebral vasospasm after cerebral aneurysm embolization can effectively improve the consciousness, inhibit inflammatory cytokine expression and reduce cerebral blood flow, also promote the repair of nerve injury.