川芎嗪注射液联合尼莫地平治疗颅内动脉瘤术后脑血管痉挛的疗效及对血浆IL-6、TNF-α、ET-1、NO水平的影响

The Clinical Efficacy of Ligustrazine Hydrochloride Injection and Nimodipine in the Treatment of Cerebral Angiospasm after Intracranial Aneurysm Surgery and Its Effect on the Plasma IL-6,TNF-α,ET-1,and NO Levels in Patients

目的探讨川芎嗪注射液联合尼莫地平治疗颅内动脉瘤(IA)术后脑血管痉挛(CVS)的临床效果及对血浆白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、内皮素(ET)-1、一氧化氮(NO)水平的影响。方法选取我院2015年1月-2017年7月收治的82例IA术后CVS病人,按照随机数字表法均分为两组。对照组41例给予尼莫地平治疗,观察组41例在此基础上加用川芎嗪注射液治疗。记录比较两组临床疗效,治疗前后蒙特利尔认知评估量表(MoCA)评分及血浆IL-6、TNF-α、ET-1、NO水平变化,不良反应发生情况。结果治疗14 d后,观察组总有效率达92.7%,较对照组(75.6%)明显升高(P=0.034)。两组治疗14 d后MoCA评分、血浆NO水平较治疗前均显著升高(P<0.01),且观察组上升较对照组同期比较差异有统计学意义(P<0.01)。与治疗前相比,两组治疗14 d后血浆IL-6、TNF-α、ET-1水平均下降(P<0.01);且观察组与对照组比较差异有统计学意义(P<0.01)。观察组不良反应率为14.6%,与对照组(9.8%)对比,差异无统计学意义(P>0.05)。结论川芎嗪注射液联合尼莫地平治疗颅内动脉瘤术后脑血管痉挛更能有效缓解病人症状体征,促进神经功能恢复,改善认知功能,且安全可靠,可能与其改善血浆中IL-6、TNF-α、ET-1、NO水平有关。

Objective To investigate the clinical efficacy of ligustrazine hydrochloride injection(LHI) and nimodipine in the treatment of cerebral vasospasm(CVS) after intracranial aneurysm(IA) surgery and its effect on the plasma interleukin(IL)-6,tumor necrosis factor(TNF)-α,endothelin(ET)-1,nitric oxide(NO) levels in patients.Methods Eighty-two patients with CVS after IA surgery in our hospital from January 2015 to July 2017 were randomly divided into two groups:control group(n=41) treated with nimodipine,and observation group(n=41) treated with LHI in the basis of nimodipine for 14 days.The clinical efficacy,changes of Montreal Cognitive Assessment(MoCA) scores and plasma IL-6,TNF-α,ET-1,NO levels before and after treatment,as well as the incidence of adverse reactions were recorded and compared between the two groups.Results After 14 days of treatment,the overall effective rate was 92.7% in the observation group,which was higher than that in the control group(75.6%,P<0.01).The MoCA scores and NO levels of both group after 14 days of treatment increased remarkably as compared with those before treatment(P<0.01),and the improvement of the observation group was more significant than that of the control group(P<0.01).Compared with those before treatment,the plasma IL-6,TNF-α,ET-1 levels of both groups after 14 days of treatment were lower(P<0.01),and the decrease of the observation group in the above indicators was more significant than that of the control group over the identical time points(P<0.01).The incidence of adverse reactions was 14.6% in the observation group,and 9.8% in the control group,and there was no significant difference between two groups(P>0.05).Conclusion The combination of LHI and nimodipine can relieve the symptoms,promote the recovery of neurologic function,and improve the cognitive function,which might be related to improving the IL-6,TNF-α,ET-1,NO levels in patients with CVS after IA surgery.