应用依达拉奉联合马来酸桂哌齐特治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的效果观察

Effect of edaravone combined with cinepazide maleate on cerebral vasospasm after aneurysmal subarachnoid hemorrhage

目的探讨马来酸桂哌齐特联合依达拉奉治疗动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后脑血管痉挛(cerebral vaso spasm,CVS)的临床疗效。方法纳入2015年7月至2018年7月本院收治的80例aSAH后CVS患者,根据随机数字表法将患者分为观察组和对照组,每组40例。对照组给予依达拉奉治疗,观察组在对照组基础上加用马来酸桂哌齐特治疗,疗程2周。分别采用格拉斯哥昏迷指数(glasgow coma scale,GCS)评分法、Barthel指数及神经功能缺损评分(neurological deficit score,NIHSS)对患者治疗前、后意识障碍程度、生活质量和神经功能缺损情况;采用经颅多普勒检测患者治疗前、后大脑后动脉(posterior cerebral artery,PCV)、双侧大脑前动脉(anterior cerebral arteries,ACA)和大脑中动脉(middle cerebral artery,MCA)的血流速度;记录患者治疗前、后血清白介素(interleukin,IL)-6、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、一氧化氮和内皮素(endothelin,ET)-1水平,统计不良反应发生情况。结果观察组治疗总有效率(92.50%)高于对照组(67.50%,P<0.05);两组治疗后的Barthel评分、GCS评分均高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组治疗后的NIHSS评分均低于治疗前(P<0.05),且观察组低于治疗组(P<0.05);治疗后,两组患者PCV、ACA和MCA水平均升高,且观察组高于对照组(P<0.05);观察组IL-6、hs-CRP、TNF-α和ET-1水平均较治疗前降低(P<0.05),一氧化氮水平升高(P<0.05),且观察组优于对照组(P<0.05)。观察组药物相关不良反应发生率为12.50%,低于对照组的15.00%,但差异无统计学意义(P>0.05),但未见肝、肾功能损伤及粒性白细胞减少等严重不良反应。结论应用马来酸桂哌齐特联合依达拉奉疗治疗aSAH后CVS患者效果确切,可改善血管内皮功能及微循环,提高患者生活质量,改善预后,且安全性较好。

Objective To investigate the clinical efficacy of cinepazide maleate combined with edaravone in the treatment of cerebral vasospasm(CVS)after aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 80 patients with CVS after aSAH in our hospital from July 2015 to July 2018 were enrolled and randomly divided into observation group and control group,40 cases in each group.The control group was treated with edaravone,and the observation group was treated with cinepazide maleate on the basis of the control group for 2 weeks.Glasgow Coma Scale(GCS),Barthel Index and neurologic defect score(NIHSS)were used to evaluate the degree of consciousness disturbance,quality of life and neurological deficit before and after treatment,and the posterior cerebral artery(PCA)was detected by transcranial Doppler before and after treatment The blood flow velocity of PCV,bilateral anterior cerebral artery(ACA)and middle cerebral artery(MCA)were recorded,and the serum interleukin(IL)-6,high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor(TNF)-α,nitric oxide and endothelin(ET)-1 were statistically analyzed.Result The total effective rate of the observation group(92.50%)was higher than that of the control group(67.50%,P<0.05).The Barthel score and GCS score of the two groups after treatment were higher than those before treatment(P<0.05),and the observation group was higher than the control group(P<0.05).The NIHSS scores of the two groups after treatment were lower than those before treatment(P<0.05),and the observation group was lower than the treatment group(P<0.05).After treatment,the PCV,ACA and MCA levels of the two groups were increased,The levels of IL-6,hs-CRP,TNF-αand ET-1 in the observation group were lower than those before treatment(P<0.05),and the level of nitric oxide was increased(P<0.05),and the observation group was better than the control group(P<0.05).The incidence of drug-related adverse reactions in the observation group was 12.50%,which was lower than 15.00%of the control group,but the difference was not statistically significant(P>0.05).However,there were no serious adverse reactions such as liver and kidney function damage and granulocytopenia.Conclusion Cinepazide maleate combined with edaravone is effective in the treatment of CVS after aSAH,which can improve vascular endothelial function and microcirculation,improve the quality of life of patients,improve the prognosis,and has good safety.