颅内动脉瘤夹闭术联合rHu-EPO、依达拉奉对动脉瘤性SAH患者氧化应激、神经损伤的影响

Effects of intracranial aneurysm clipping combined with rHu EPO and edaravone on oxidative stress and nerve injury in patients with aneurysmal SAH

目的探讨颅内动脉瘤夹闭术联合重组人促红细胞生成素(rHu-EPO)、依达拉奉对动脉瘤性蛛网膜下腔出血(SAH)的临床效果。方法采用前瞻性研究方法,选取2019年1月至2022年1月在中南大学湘雅医院治疗的动脉瘤性SAH患者78例,采用信封法将患者随机分为观察组(n=39)和对照组(n=39)。对照组给予颅内动脉瘤夹闭术,观察组在对照组基础上联合rHu-EPO、依达拉奉治疗。观察两组手术前后脑氧供需、氧化应激、美国国立卫生院神经功能缺损评分(NIHSS)评分、简易智力状态检查量表(MMSE)评分、日常生活能力(ADL)及并发症发生情况。结果术后24 h,观察组的颈内静脉血氧饱和度(SjvO_(2))、颈内静脉血氧含量(CjvO_(2))、动脉血氧含量(CaO_(2))、颈内动-静脉血氧含量差(Ca-JvO_(2))和脑氧饱和度(rSO_(2))为(60.03±4.11)%、(9.20±1.21)%、(13.35±1.34)%、(5.03±0.97)%和(67.56±9.94)%,均明显高于对照组[(54.43±6.89)%、(8.03±1.15)%、(10.08±1.41)%、(4.36±0.91)%、(61.18±10.41)%],差异均有统计学意义(P<0.05)。术后24 h,观察组的超氧化物岐化酶(SOD)和过氧化氢酶(CAT)分别为(88.52±11.79)、(68.89±8.14)U/mL,均明显高于对照组[(79.92±12.15)、(62.29±8.03)U/mL],而丙二醛为(5.51±0.97)mmol/L,明显低于对照组[(6.02±0.91)mmol/L],差异均有统计学意义(P<0.05)。观察组术后1个月美国国立卫生院神经功能缺损评分(NIHSS)评分为(6.01±1.06)分,明显低于对照组[(7.25±1.03)分],而简易智力状态检查量表(MMSE)评分和日常生活能力(ADL)评分分别为(26.16±2.09)、(66.67±4.51)分,明显高于对照组[(25.20±1.91)、(60.09±5.22)分],差异均有统计学意义(P<0.05)。观察组的脑血管痉挛发生率为5.13%,明显低于对照组(20.51%),差异有统计学意义(P<0.05)。结论颅内动脉瘤夹闭术联合rHu-EPO、依达拉奉治疗动脉瘤性SAH患者有较好的效果,具有氧化应激反应轻、保护患者神经功能、改善脑氧供需平衡及脑氧饱和度等优点。

Objective To investigate the clinical effect of intracranial aneurysm clipping combined with recombinant human erythropoietin(rHu-EPO)and edaravone on aneurysmal subarachnoid hemorrhage(SAH).Methods Prospective research methods,78 patients with aneurysmal SAH treated in Xiangya Hospital,Central South University from January 2019 to January 2022 were selected.The patients were divided into observation group(n=39)and control group(n=39)by envelope method.The control group was treated with intracranial aneurysm clipping.The observation group was treated with rHu-EPO and edaravone on the basis of the control group.The cerebral oxygen supply and demand,oxidative stress and National Institutes of Health Neurological Deficit Score(NIHSS),Mini-Mental State Examination(MMSE),activities of daily living(ADL)and complication before and after the operation were observed.Results The internal jugular vein oxygen saturation(SjvO_(2)),internal jugular vein oxygen content(CjvO_(2)),arterial oxygen content(CaO_(2)),internal jugular artery venous oxygen content difference(Ca-jvO_(2))and cerebral oxygen saturation(rSO_(2))in the observation group at 24 hours after operation were(60.03±4.11)%,(9.20±1.21)%,(13.35±1.34)%,(5.03±0.97)%and(67.56±9.94)%,which were significantly higher than those in the control group[(54.43±6.89)%,(8.03±1.15)%,(10.08±1.41)%,(4.36±0.91)%,(61.18±10.41)%],the differences were statistically significant(P<0.05).At 24 hours after operation,the superoxide dismutase(SOD)and catalase(CAT)in the observation group were(88.52±11.79)and(68.89±8.14)U/mL,respectively,which were significantly higher than those in the control group[(79.92±12.15),(62.29±8.03)U/mL],while the malondialdehyde was(5.51±0.97)mmol/L,which was significantly lower than that of the control group[(6.02±0.91)mmol/L],the differences were statistically significant(P<0.05).The NIHSS in the observation group were(6.01±1.06)points,which were significantly lower than those in the control group[(7.25±1.03)points],the scores of MMSE and ADL were(26.16±2.09)and(66.67±4.51)points,respectively,which were significantly higher than those in the control group[(25.20±1.91),(60.09±5.22)points],the differences were statistically significant(P<0.05).The incidence of cerebral vasospasm in the observation group was 5.13%,which was significantly lower than that in the control group(20.51%),the difference was statistically significant(P<0.05).Conclusion Intracranial aneurysm clipping combined with rHu-EPO and edaravone has a good effect on patients with aneurysmal SAH,has the advantages of mild oxidative stress response,protection of patients’neurological function,improvement of cerebral oxygen supply and demand balance and cerebral oxygen saturation.