高血压脑出血患者应用依达拉奉联合局部亚低温治疗对患者神经损伤和认知功能的影响

The effects of edaravone combined with local mild hypothermia on neurological injury and cognitive function in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血(HICH)患者应用依达拉奉联合局部亚低温治疗对患者神经损伤和认知功能的影响。方法我院94例SICH患者,采用随机数字表法分为观察组和对照组各47例,均给予依达拉奉等常规治疗和护理,观察组在此基础上加用局部亚低温疗法,疗程14d,比较两组血肿体积、神经功能缺损程度评分量表(NDS)、血管内皮生长因子(VEGF)水平及蒙特利尔认知量表(MoCA)评分变化,随访两组并发症和治疗6月时日常生活能力(ADL)。结果治疗第1d两组NDS评分和血清VEGF水平升高,对照组血肿体积增加(P<0.05),治疗第7d和第14d两组血肿体积、NDS评分及血清VEGF水平降低(P<0.05),观察组治疗1、7、14d血肿体积、NDS评分以及血清VEGF水平均低于对照组(P<0.05);治疗第3、6月两组MoCA评分均升高,且观察组高于对照组(P<0.05);观察组治疗效果优于对照组(P<0.05)。结论局部亚低温联合依达拉奉治疗HICH有利于降低血清VEGF水平和促进血肿吸收,同时减轻神经损伤并促进患者认知功能恢复,对改善患者日常生活能力和预后具有积极作用。

Objective To investigate the effects of edaravone combined with local mild hypothermia on neurological injury and cognitive function in patients with hypertensive intracerebral hemorrhage( HICH). Methods Ninety-four patients with HICH in our hospital were divided into observation and control groups according to the random number table method of admission sequence,47 in each group.All patients were treated with edaravone and other routine treatment and nursing.The observation group was additionally given local mild hypothermia on this basis,and they were treated for 14 d.The hematoma volume,neurological deficit scale( NDS),vascular endothelial growth factor( VEGF) level and Montreal cognitive scale( MoCA) score were compared between the two groups.The complications and ability of daily living( ADL) after 6 months of treatment were followed up.Results On the 1 stday of treatment,the NDS score and serum VEGF level in the two groups were significantly increased( P < 0. 05),and the hematoma volume in control group was significantly increased( P < 0. 05).The hematoma volume,NDS score and serum VEGF level in the two groups on the 7 thday and the14 thday of treatment were significantly decreased( P < 0. 05).The hematoma volume,NDS score and serum VEGF level in the observation group were lower than those in the control group on the 1 stday,the 7 thday and the 14 thday of treatment( P < 0. 05).On the 3 rdmonth and 6 thmonth of treatment,the MoCA scores in the two groups were significantly increased( P < 0. 05),and the MoCA score in the observation group was higher than that in the control group( P < 0. 05). The good prognosis rates in the two groups were 87. 23% and70. 21%,respectively( P < 0. 05). The therapeutic effects in the observation group were significantly better than those in the control group( P < 0. 05).Conclusion Local mild hypothermia combined with edaravone in the treatment of HICH is beneficial to reduce serum VEGF level and promote hematoma absorption,and it can also reduce the neurological injury and promote the cognitive function recovery.These have a positive effect on improving daily living ability and prognosis of the patients.