乌司他丁对颅内动脉瘤患者介入栓塞术后脑血管痉挛的预防作用及对血管内皮功能的影响

Preventive effect of ulinastatin on cerebral vasospasm after interventional embolization in patients with intracranial aneurysm and its effect on vascular endothelial function

目的探讨乌司他丁对颅内动脉瘤患者介入栓塞术后脑血管痉挛的预防作用及对血管内皮功能的影响。方法选取2017年5月至2021年4月在汉中市中心医院神经外科行介入栓塞术的92例颅内动脉瘤患者为研究对象,依据随机数表法分为对照组和研究组各46例。术前,对照组患者使用0.9%氯化钠液干预,研究组患者在对照组治疗的基础上使用乌司他丁干预。术后7 d,比较两组患者脑血管痉挛发生率与持续时间、手术前及手术后7 d格拉斯哥昏迷指数(GCS)评分及血清内皮素-1(ET-1)、血管性血友病因子(vWF)、一氧化氮(NO)水平。结果术后7 d,研究组患者的脑血管痉挛发生率为8.70%,明显低于对照组的30.43%,而脑血管痉挛持续时间为(3.76±1.42)d,明显短于对照组的(8.69±1.88)d,差异均有统计学意义(P<0.05);手术前,两组患者的GCS评分、ET-1、vWF、NO比较差异均无统计学意义(P>0.05);手术后7 d,研究组患者的ET-1水平为(542.84±94.38)pg/mL,明显低于对照组的(587.40±114.29)pg/mL,GCS评分、vWF、NO水平分别为(10.32±1.58)分、(30.32±5.88)ng/mL、(1.56±0.15)nmol/mL,明显高于对照组的(8.97±1.96)分、(26.84±5.51)ng/mL、(1.48±0.13)nmol/mL,差异均有统计学意义(P<0.05)。结论乌司他丁应用于颅内动脉瘤介入栓塞术中可预防患者脑血管痉挛,同时能显著改善其血管内皮功能,具有推广应用价值。

Objective To investigate the preventive effect of ulinastatin on cerebral vasospasm in patients with intracranial aneurysm after interventional embolization and its effect on vascular endothelial function.Methods Ninety-two patients with intracranial aneurysm who underwent interventional embolization in the Department of Neurosurgery,Hanzhong Central Hospital from May 2017 to April 2021 were selected as the research objects.According to the random number table method,they were divided into the control group and the study group,with 46 cases in each group.Before operation,the control group was treated with 0.9%sodium chloride solution,and the study group was treated with ulinastatin on the basis of the control group.The incidence and duration of cerebral vasospasm,Glasgow Coma Index(GCS)score,and serum levels of endothelin-1(ET-1),von Willeblood factor(vWF),and nitric oxide(NO)before surgery and 7 days after surgery were compared between the two groups.Results At 7 days after surgery,the incidence of cerebral vasospasm in the study group was 8.70%,which was significantly lower than 30.43%in the control group(P<0.05);the duration of cerebral vasospasm in the study group was(3.76±1.42)d,which was significantly shorter than(8.69±1.88)d in the control group(P<0.05).Before surgery,there was no significant difference in the GCS score,ET-1,vWF,and NO between the two groups(P>0.05);at 7 days after surgery,the levels of ET-1 in the study group were(542.84±94.38)pg/mL,which was significantly lower than(587.40±114.29)pg/mL in the control group;GCS score,vWF,NO levels were(10.32±1.58)points,(30.32±5.88)ng/mL,(1.56±0.15)nmol/mL,significantly higher than(8.97±1.96)points,(26.84±5.51)ng/mL,(1.48±0.13)nmol/mL in the control group(P<0.05).Conclusion Ulinastatin can prevent cerebral vasospasm in patients during interventional embolization of intracranial aneurysms,and can significantly improve the endothelial function of their blood vessels,which has the value of promotion and application.