尼莫地平与前列地尔联合治疗动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者炎症因子和ET-1、CGRP、VEGF水平的影响
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摘要
目的探讨尼莫地平与前列地尔联合治疗动脉瘤性蛛网膜下腔出血(aSAH)伴脑血管痉挛(CVS)的临床疗效及对患者血清炎症因子和内皮素-1(ET-1)、降钙素基因相关肽(CGRP)、血管内皮生长因子(VEGF)水平的影响。方法纳入2015年1月至2018年8月遂宁市中医院收治的86例aSAH伴CVS患者,随机分为观察组和对照组,各43例,对照组给予尼莫地平治疗,观察组给予尼莫地平与前列地尔联合治疗,连续治疗2w后,统计临床疗效,记录患者治疗前后血清白介素(IL)-6、IL-8、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、内皮素-1(ET-1)、降钙素基因相关肽(CGRP)、血管内皮生长因子(VEGF)水平、蒙特利尔认知评估量表(MOCA)评分、Barthel指数评分,并统计不良反应发生情况。结果观察组治疗总有效率显著高于对照组(93.02%VS 76.74%),P<0.05;两组治疗后的血清IL-6、IL-8、hs-CRP、TNF-α、ET-1、VEGF水平均显著低于治疗前(P<0.05),且观察组低于对照组(P<0.05),两组治疗后的CGRP水平均显著高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组治疗后的MOCA评分和Barthel评分均显著高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组患者无肝、肾功能损害等严重并发症发生。结论尼莫地平与前列地尔联合治疗aSAH伴CVS效果满意,可有效提高患者生活质量,改善认知功能和血管内皮功能,降低炎症反应。
Objective To investigate the clinical efficacy of nimodipine combined with alprostadil in the treatment of aneurysmal subarachnoid hemorrhage(aSAH)with cerebral vasospasm(CVS)and serum inflammatory factors and endothelin-1(ET-1),calcium dehydration Effects of gene-related peptide(CGRP)and vascular endothelial growth factor(VEGF)levels.Method 86 patients with aSAH and CVS admitted to our hospital from January 2015 to August 2018 randomly divided into observation group and control group,43 cases each.the control group was treated with alprostadil.The observation group was treated with nimodipine and alprostadil.After continuous treatment for 2 w,the clinical effic acy was calculated.The serum interleukin(IL)-6,IL-8 and hypersensitive C responses were recorded before and after treatment,protein(hs-CRP),tumor necrosis factor(TNF)-α.ET-1,CGRP,VEGF levels,Montreal cognitive assessment table(MOCA)score,barthel index score,and statistics of adverse reactions.Results The total effective rate of the observation group was significantly higher than that of the control group(93.02% vs 76.74%),P<0.05.The levels of serum IL-6,IL-8,hs-CRP,TNF-α,ET-1 and VEGF in the two groups were significantly lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05),levels of CGRP in the two groups were significantly higher than those before treatment(P<0.05),and the observation group was higher than the control group(P<0.05).The MOCA score and Barthel score after treatment were significantly higher than those before treatment(P<0.05),and the observation group was higher than the control group(P<0.05).There were no serious complications such as liver and kidney damage in the two groups.Conclusion The combination of nimodipine and alprostadil in the treatment of aSAH with CVS is effective,can improve the quality of life of patients,improve cognitive function and endothelial function,and reduce inflammation.
Objective To investigate the clinical efficacy of nimodipine combined with alprostadil in the treatment of aneurysmal subarachnoid hemorrhage(aSAH)with cerebral vasospasm(CVS)and serum inflammatory factors and endothelin-1(ET-1),calcium dehydration Effects of gene-related peptide(CGRP)and vascular endothelial growth factor(VEGF)levels.Method 86 patients with aSAH and CVS admitted to our hospital from January 2015 to August 2018 randomly divided into observation group and control group,43 cases each.the control group was treated with alprostadil.The observation group was treated with nimodipine and alprostadil.After continuous treatment for 2 w,the clinical effic acy was calculated.The serum interleukin(IL)-6,IL-8 and hypersensitive C responses were recorded before and after treatment,protein(hs-CRP),tumor necrosis factor(TNF)-α.ET-1,CGRP,VEGF levels,Montreal cognitive assessment table(MOCA)score,barthel index score,and statistics of adverse reactions.Results The total effective rate of the observation group was significantly higher than that of the control group(93.02% vs 76.74%),P<0.05.The levels of serum IL-6,IL-8,hs-CRP,TNF-α,ET-1 and VEGF in the two groups were significantly lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05),levels of CGRP in the two groups were significantly higher than those before treatment(P<0.05),and the observation group was higher than the control group(P<0.05).The MOCA score and Barthel score after treatment were significantly higher than those before treatment(P<0.05),and the observation group was higher than the control group(P<0.05).There were no serious complications such as liver and kidney damage in the two groups.Conclusion The combination of nimodipine and alprostadil in the treatment of aSAH with CVS is effective,can improve the quality of life of patients,improve cognitive function and endothelial function,and reduce inflammation.
引文
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[11]徐敬轩,栾新平.前列地尔联合尼莫地平防治动脉瘤性蛛网膜下腔出血致脑血管痉挛28例[J].中国药业,2016,25(3):121-123.
[12]Sundararajan K,Roberts-Thomson R L,Nelson A J,et al.Therapeutic paradox:nimodipine attenuates severe coronary spasm following coronary artery graft surgery in a high-risk vasoplegic cancer patient[J].Int Med J,2017,47(2):229.
[13]Abboud T,Andresen H,Koeppen J,et al.Serum levels of nimodipine in enteral and parenteral administration in patients with aneurysmal subarachnoid hemorrhage[J].Acta Neurochir,2015,157(5):763-767.
[14]Ott S,Jedlicka S,Wolf S,et al.Continuous selective intra-arterial application of nimodipine in refractory cerebral vasospasm due to aneurysmal subarachnoid hemorrhage[J].Biomed Res Int,2014,2014:970741.
[15]Hockel K,Diedler J,Steiner J,et al.Long-term,continuous intraarterial nimodipine treatment of severe vasospasm following aneurysmal subarachnoid hemorrhage[J].World Neurosurg,2016,88(21):104-112.
[16]Sandow N,Diesing D,Sarrafzadeh A,et al.Nimodipine dose reductions in the treatment of patients with aneurysmal subarachnoid hemorrhage[J].Neurocritical Care,2016,25(1):29-39.
[17]Wessell A,Kole M J,Badjatia N,et al.High compliance with scheduled nimodipine is associated with better outcome in aneurysmal subarachnoid hemorrhage patients cotreated with heparin infusion[J].Front Neurol,2017,8(15):268.
[18]Cho S,Bales J,Tran TK,et al.Effects of 14 versus 21 days of nimodipine therapy on neurological outcomes in aneurysmal subarachnoid hemorrhage patients[J].Ann Pharmacother,2016,50(9):718-724.
[19]张岚.前列地尔联合尼莫地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效[J].临床和实验医学杂志,2015,33(22):1878-1880.
[20]Fontana J,Moratin J,Ehrlich C,et al.Dynamic autoregulatory response after aneurysmal subarachnoid hemorrhage and its relation to angiographic vasospasm and clinical outcome[J].Neurocrit Care,2015,23(3):355-363.
[2]Park YK,Yi HJ,Choi KS,et al.Predictive factors of fever after aneurysmal subarachnoid hemorrhage and its impact on delayed cerebral ischemia and clinical outcomes.[J].World Neurosur,2018,114:es24-es31.
[3]Hockel K.Diedler J,Steiner J,et al.Long-term,continuous intraarterial nimodipine treatment of severe vasospasm following aneurysmal subarachnoid hemorrhage.[J].World Neurosurg.2016,88:104-1 12.
[4]中华医学会神经外科学分会·脑血管痉挛防治神经外科专家共识[J].中华医学杂志,2008,88(31):2161-2165.
[5]Wong A,Law LS,Liu W,et al.Montreal cognitive assessmen:one cutoff neverfits all.[J].Stroke,2015,44(12):3547-3550.
[6]Wong GK,Lee A,Wong A,et al.Clinically important difference of stroke-specific quality of life scale for aneurysmal subarachnoid hemorrhage[J].Clin Neurosci,2016.33:209-212.
[7]Petridis AK,Kamp MA,Cornelius JF,et al.Aneurysmal subarachnoid hemorrhage.[J].Dtsch Arztehl Int,2017,114(13):226-236.
[8]Matsuda N,Naraoka M,Ohkuma H,et al.Effect of eilostazol on cerebral vasospasm and outcome in patients with aneurysmal subarachnoid hemorrhage:a randomized,double-blind,placebocontrolled trial[J].Cerebrovasc Dis,2016,42(1-2):97-105.
[9]Karic T,Rφe C,Nordenmark T H,el al.Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage[J].J Neurosurg,2017,126(2):518-526.
[10]Lucke-Wold BP,Logsdon A F,Branavan M,et al.Aneurysmal suharachnoid hemorrhage and neuroinflammation:a comprehensive review:[J].Int Mol Sci,2016,17(4):497.
[11]徐敬轩,栾新平.前列地尔联合尼莫地平防治动脉瘤性蛛网膜下腔出血致脑血管痉挛28例[J].中国药业,2016,25(3):121-123.
[12]Sundararajan K,Roberts-Thomson R L,Nelson A J,et al.Therapeutic paradox:nimodipine attenuates severe coronary spasm following coronary artery graft surgery in a high-risk vasoplegic cancer patient[J].Int Med J,2017,47(2):229.
[13]Abboud T,Andresen H,Koeppen J,et al.Serum levels of nimodipine in enteral and parenteral administration in patients with aneurysmal subarachnoid hemorrhage[J].Acta Neurochir,2015,157(5):763-767.
[14]Ott S,Jedlicka S,Wolf S,et al.Continuous selective intra-arterial application of nimodipine in refractory cerebral vasospasm due to aneurysmal subarachnoid hemorrhage[J].Biomed Res Int,2014,2014:970741.
[15]Hockel K,Diedler J,Steiner J,et al.Long-term,continuous intraarterial nimodipine treatment of severe vasospasm following aneurysmal subarachnoid hemorrhage[J].World Neurosurg,2016,88(21):104-112.
[16]Sandow N,Diesing D,Sarrafzadeh A,et al.Nimodipine dose reductions in the treatment of patients with aneurysmal subarachnoid hemorrhage[J].Neurocritical Care,2016,25(1):29-39.
[17]Wessell A,Kole M J,Badjatia N,et al.High compliance with scheduled nimodipine is associated with better outcome in aneurysmal subarachnoid hemorrhage patients cotreated with heparin infusion[J].Front Neurol,2017,8(15):268.
[18]Cho S,Bales J,Tran TK,et al.Effects of 14 versus 21 days of nimodipine therapy on neurological outcomes in aneurysmal subarachnoid hemorrhage patients[J].Ann Pharmacother,2016,50(9):718-724.
[19]张岚.前列地尔联合尼莫地平治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效[J].临床和实验医学杂志,2015,33(22):1878-1880.
[20]Fontana J,Moratin J,Ehrlich C,et al.Dynamic autoregulatory response after aneurysmal subarachnoid hemorrhage and its relation to angiographic vasospasm and clinical outcome[J].Neurocrit Care,2015,23(3):355-363.