甘露醇联合神经节苷脂注射液治疗急性高血压脑出血疗效观察

Clinical effect of mannitol combined with ganglioside injection in treatment of acute hypertensive cerebral hemorrhage

目的探讨甘露醇联合神经节苷脂注射液治疗急性高血压脑出血的临床效果及对患者认知功能和血清S100B蛋白(S100B)、胰岛素样生长因子1(IGF-1)、神经元特异性烯醇化酶(NSE)水平的影响。方法选择2015年11月至2018年1月南阳市中心医院神经内科收治的94例急性高血压脑出血患者为研究对象,按照随机数字分组法分为对照组与观察组,每组47例。2组患者均给予持续吸氧、控制惊厥、预防应激性溃疡、脱水降颅压、维持水电解质平衡等常规治疗;同时,对照组患者给予单纯甘露醇治疗,观察组患者给予甘露醇联合神经节苷脂注射液治疗,疗程均为2周。根据CT扫描结果计算2组患者治疗前后脑水肿面积及血肿体积,采用酶联免疫吸附试验检测2组患者治疗前后血清S100B、IGF-1水平,电化学发光免疫法检测2组患者治疗前后血清NSE水平。根据美国国立卫生研究院卒中量表(NIHSS)标准评定2组患者的临床效果,根据Barthel指数(BI)评估2组患者治疗前后日常生活能力,依据简易精神状态表(MMSE)判断2组患者治疗前后认知功能。结果2组患者治疗前脑水肿面积、血肿体积、NIHSS、BI、MMSE评分及血清S100B、NSE、IGF-1水平比较差异均无统计学意义(P>0.05)。与治疗前比较,2组患者治疗后脑水肿面积、血肿体积、NIHSS评分均显著减小(P<0.05),血清S100B、NSE水平显著降低(P<0.05),BI、MMSE评分均显著增高(P<0.05),血清IGF-1水平显著升高(P<0.05)。观察组患者治疗后脑水肿面积、血肿体积、NIHSS评分与对照组比较显著减小(P<0.05),BI、MMSE评分及血清IGF-1水平显著增高(P<0.05)。对照组和观察组患者治疗总有效率分别为65.96%(31/47)、95.74%(45/47),观察组患者治疗总有效率显著高于对照组(χ^2=13.468,P<0.05)。对照组和观察组患者不良反应发生率分别为6.38%(3/47)、10.64%(5/47),2组患者不良反应发生率比较差异无统计学意义(χ^2=0.547,P>0.05)。结论甘露醇联合神经节苷脂注射液治疗急性高血压脑出血,可明显改善患者的临床症状,缩小脑水肿面积、血肿体积,降低血清S100B、NSE水平,升高血清IGF-1水平,有效改善患者的认知功能,提高患者的生活质量。

Objective To investigate the clinical effect of mannitol combined with ganglioside injection in treatment of acute hypertensive intracerebral hemorrhage and its effects on the cognitive function of patients and serum levels of Sangtec-100B protein(S100B),insulin-like growth factor-1(IGF-1)neuron-specific enolase(NSE)levels.Methods Ninety-four patients with acute hypertensive intracerebral hemorrhage admitted to the Department of Neurology,Nanyang Central Hospital from November 2015 to January 2018 were selected as the study subjects.The patients were divided into control group and observation group according to the random number table method,with 47 cases in each group.All patients were given routine treatment such as continuous oxygen inhalation,convulsion control,stress ulcer prevention,dehydration and intracranial pressure reduction,and maintenance of water and electrolyte balance.Based on this,the patients in the control group were treated with mannitol alone;the patients in the observation group were treated with mannitol and ganglioside injection for two weeks.The brain edema area and hematoma volume were calculated according to CT scanning results before and after treatment.The serum levels of S100B and IGF-1 of patients were detected by enzyme linked immunosorbent assay before and after treatment in the two groups.The serum levels of neuron specific enolase(NSE)of patients were detected by electrochemiluminescent immunoassay before and after treatment in the two groups.The clinical effects of all patients were assessed by the national institutes of health stroke scale(NIHSS)standard;the daily living ability was assessed by barthel index(BI)before and after treatment;and the cognitive function was assessed by the mini mental state examination(MMSE)before and after treatment.Results There was no significant difference in the brain edema area,hematoma volume,NIHSS,BI,MMSE scores and serum levels of S100B,NSE and IGF-1 between the two groups before treatment(P>0.05).Compared with that before treatment,the area of brain edema,volume of hematoma,NIHSS score and the serum levels of S100B and NSE decreased significantly after treatment(P<0.05);the scores of BI,MMES and the serum levels of IGF-1 increased significantly in the two groups(P<0.05).Compared with the control group,the area of brain edema,volume of hematoma and NIHSS score of patients in the observation group were significantly decreased(P<0.05);while the scores of BI,MMES and serum levels of IGF-1 were significantly increased After treatment(P<0.05).The total effective rate of patients in the control group and the observation group was 65.96%(31/47)and 95.74%(45/47)respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group(χ^2=13.468,P<0.05).The incidence of adverse reactions of patients in control group and observation group was 6.38%(3/47)and 10.64%(5/47)respectively;there was no significant difference in the incidence of adverse reactions between the two groups(χ^2=0.547,P>0.05).Conclusion Mannitol combined with ganglioside injection in the treatment of acute hypertensive intracerebral hemorrhage can significantly improve the clinical symptoms,reduce the size of brain edema and hematoma volume,reduce the serum levels of S100B and NSE,increase the serum level of IGF-1,effectively improve the cognitive function of patients,and help to improve the quality of life of patients.