瑞马唑仑镇静治疗对脑动脉瘤破裂介入术后迟发性脑缺血患者近期应激指标和预后的影响

Effects of Remiazolam Sedation on Short-Term Stress Indexes and Prognosis in Patients with Delayed Cerebral Ischemia After Interventional Therapy for Intracranial Aneurysm Rupture

目的 探讨瑞马唑仑镇静治疗对脑动脉瘤破裂介入术后迟发性缺血障碍患者近期应激指标和预后的影响。方法 选择2021年4月至2023年4月开封市人民医院治疗的98例蛛网膜下腔出血介入后患者,随机分为A组(瑞马唑仑0.05 mg·kg^(-1)·h^(-1))32例、AA组(瑞马唑仑0.15 mg·kg^(-1)·h^(-1))32例和对照组(无瑞马唑仑)34例,3组患者均连续治疗14 d。预后评估采用美国国立卫生研究院卒中量表评分为准,≥15分评定为预后差,<15分为预后良好。比较3组患者治疗前后体内应激指标β-内啡肽(β-EP)、S100β蛋白、神经元特异性烯醇化酶(NSE)水平变化和3组迟发性脑缺血脑血管痉挛的发生率和预后影响。结果 3组患者治疗前β-EP、S100β、NSE水平比较,差异无统计学意义(P>0.05);AA组治疗后血清β-EP、S100β、NSE降低水平优于A组和对照组,差异有统计学意义(P<0.05);3组治疗前迟发性脑缺血脑血管痉挛发生时间差异无统计学意义(P>0.05);AA组脑血管痉挛发生后持续时间和发生率优于A组和对照组,差异有统计学意义(P<0.05);预后良好的患者中AA组为84.3%,整体预后优于A组(58.8%)和对照组(56.2%),差异有统计学意义(P<0.05)。3组患者不良反应A组总发生率11.4%,AA组总发生率15.6%,对照组发生率为8.8%,差异无统计学意义(P>0.05)。结论 瑞马唑仑镇静治疗可能改善脑组织代谢和脑血管痉挛,高水平相比低水平的瑞马唑仑有较好的脑组织保护和减少脑血管痉挛发生的作用,对脑动脉瘤破裂术后患者改善临床预后有一定的效果。

Objective To investigate the effect of remiazolam sedation on short-term stress indexes and prognosis of patients with delayed ischemic disorder after interventional therapy for ruptured Intracranial aneurysm.Methods From April 2021 to April 2023,98 patients with subarachnoid hemorrhage who were treated in Kaifeng People’s Hospital after intervention were selected and randomly divided into three groups:A group(ramazolam 0.05 mg·kg^(-1)·h^(-1))32 patients,AA group(ramazolam 0.15 mg·kg^(-1)·h^(-1))32 patients and control group(no ramazolam)34 patients.All patients were treated for 14 consecutive days.The prognosis was assessed using the National Institutes of Health Stroke Scale score,with a score≥15 indicating poor prognosis and a score<15 indicating good prognosis.The changes of stress indexβ-endorphin(β-EP),S100βprotein and neuron specific enolase(NSE)levels in 3 groups before and after treatment and the incidence and prognostic effects of delayed cerebral ischemia cerebral vasospasm in 3 groups were compared.Results There was no significant difference inβ-EP,S100βand NSE levels among 3 groups before treatment(P>0.05).The levels of serumβ-EP,S100βand NSE in group AA after treatment were better than those in A group and control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the occurrence time of delayed ischemic cerebral vasospasm among the three groups before treatment(P>0.05).The duration and incidence of cerebral vasospasm in the AA group were better than those in the A group and the control group,and the difference was statistically significant(P<0.05).Among the patients with good prognosis,AA group was 84.3%,and the overall prognosis was better than A group(58.8%)and control group(56.2%),the difference was statistically significant(P<0.05).The total incidence of adverse reactions among the three groups of patients was 11.4%in A group,15.6%in AA group,and 8.8%in the control group,with no statistically significant difference(P>0.05).Conclusion Sedative treatment of ramazolam may improve brain tissue metabolism and cerebral vasospasm.Compared with low concentration of ramazolam,high concentration of ramazolam has better brain tissue protection and reduces the occurrence of cerebral vasospasm,which has a certain effect on improving the clinical prognosis of patients with ruptured Intracranial aneurysm.