七叶皂苷钠联合甘露醇治疗脑出血的效果研究

Study on the effect of sodium aescinate combined with mannitol on cerebral haemorrhage

目的:探讨七叶皂苷钠联合甘露醇在脑出血患者中的应用价值。方法:选择2019年6月-2021年6月本院收治的脑出血患者82例,按随机数字表法分为对照组(41例)和研究组(41例)。所有患者给予对症支持治疗,在此基础上,对照组予以甘露醇治疗,甘露醇浓度为20%,按照患者体重调整剂量为0.25~2 g/kg,将其溶于250 ml葡萄糖注射液中静滴,在4~6 h内静滴完毕,1次/d;研究组在对照组基础上加用七叶皂苷钠治疗,取10 mg七叶皂苷钠溶于250 ml氯化钠注射液中静滴,1次/d,重症患者可多次给药,每日最大剂量不得超过20 mg,两组均连续治疗7 d。比较两组临床疗效、颅压控制情况、神经及认知功能[美国国立卫生研究院卒中量表(NIHSS)、简易智能精神状态检查量表(MMSE)]、血清学指标[血清神经元特异性烯醇化酶(NSE)、单核细胞趋化蛋白-1(MCP-1)、脑源性神经营养因子(BDNF)]和安全性。结果:研究组治疗总有效率高于对照组,降颅压起效时间短于对照组,降颅压持续时间长于对照组,差异有统计学意义(P<0.05)。两组治疗前NIHSS、MMSE评分及NSE、MCP-1、BDNF水平比较,差异无统计学意义(P>0.05);两组治疗14 d后NIHSS评分及NSE、MCP-1水平低于治疗前,MMSE评分及BDNF水平高于治疗前,且研究组NIHSS评分及NSE、MCP-1水平低于对照组,MMSE评分及BDNF水平高于对照组,差异有统计学意义(P<0.05)。两组不良反应相当,差异无统计学意义(P>0.05)。结论:七叶皂苷钠联合甘露醇应用于脑出血患者中能够有效降低颅压,调节NSE、MCP-1和BDNF水平,减轻患者神经功能损伤,提高认知功能,且安全可靠。

Objective:To investigate the application of sodium aescinate combined with mannitol in patients with cerebral hemorrhage.Methods:According to random number table method,a total of 82 patients with cerebral hemorrhage admitted to our hospital from June 2019 to June 2021 were selected and divided into the control group(n=41)and the study group(n=41).All patients were given symptomatic supportive treatment.On this basis,the control group was intravenously given mannitol(20%in glucose injection)with a dose of 0.25~2 g/kg per day according to the patient's body weight.On the basis of the control group,the study group was additionally treated with sodium aescinate(10 mg in 250 ml normal saline)once a day.Severe patients were given multiple doses of sodium aescinate with the maximum daily dose less than 20 mg.Both groups were treated for 7 days.The clinical curative effect,cranial pressure control,neurological and cognitive function[National Institutes of Health Stroke Scale(NIHSS)and Simple Intelligent Mental State Examination Scale(MMSE)],serum indicators[serum neuron-specific enolase(NSE),monocyte chemoprotein-1(MCP-1),and brain-derived neurotrophins(BDNF)],and safety were compared between the two groups.Results:The total effective rate in the study group was higher than that in the control group.The starting effect time of lowering the intracranial pressure was significantly shorter than that in the control group,while the intracranial pressure decreasing lasting time was significantly longer than the control group(P<0.05).There were no significant differences in NIHSS and MMSE scores and NSE,MCP-1,and BDNF levels between the two groups before treatment(P>0.05).After 14 days of treatment,NIHSS score and NSE and MCP-1 levels in both groups were lower than before treatment,while MMSE score and BDNF levels were higher than before treatment.NIHSS score and NSE and MCP-1 levels in the study group were significantly lower than the control group,while MMSE score and BDNF levels were significantly higher than the control group(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion:The application of sodium aescinate combined with mannitol can effectively reduce cranial pres-sure,regulate NSE,MCP-1,and BDNF levels in patients with cerebral hemorrhage,alleviate neurological impairment,and im-prove cognitive function,which is safe and reliable.