抑肽酶佐治脑出血脑水肿作用机制的探讨  

Mechanism of aprotinin in auxiliary treatment of cerebral hemorrhage

作　　者：周春奎[1] 吴江[1] 孟令秋[1] 

机构地区：[1]吉林大学第一医院神经科,长春130021

出　　处：《中华神经科杂志》2005年第1期22-24,共3页Chinese Journal of Neurology

摘　　要：　目的　探讨抑肽酶辅助治疗脑出血脑水肿的作用机制。方法　收集脑出血患者 83例,分为 2组,抑肽酶治疗组 42例,对照组 41例。治疗前后进行神经功能评分,测量脑水肿体积并监测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等的变化。结果　①入院后第 1、2、3周神经功能评分增加值(分)差异有统计学意义,抑肽酶治疗组 (分别为 14 5±4 3、19 0±5 2、24 0±5 0 )高于对照组 (分别为 12 7±3 8、16 8±4 8、21 7±5 4 )。②水肿产生量治疗组[ (0 212±0 064) /d) ]少于对照组[ (0 240±0 063) /d], 差异有统计学意义。③治疗前后APTT差值治疗组[ (1 2±1 8)s]高于对照组[ (0 4±1 8)s]。结论　抑肽酶能够抑制脑水肿的形成, 提高脑出血患者神经功能评分,脑出血急性期加用抑肽酶优于单独使用甘露醇。抑肽酶对激肽释放酶和激肽级联系统的抑制作用、抑肽酶减少凝血酶的产生和对血肿局部凝血酶的拮抗作用是其可能的作用机制。Objective To discuss the mechanism of aprotinin in auxiliary treatment of cerebral hemorrhage.Methods Totally 83 patients were divided into two groups: aprotinin treating group (42 cases) and control group (41 cases). The patients’ neurologic function was marked according to the European Standards of Grading For Cerebral Attacking. The volumes of edema were observed by CT in 10 days through 14 days after their attacks. The patients’ following prothrombin, activated partial thromboplastin time, and fibrinogen values were measured respectively before and after treatment.Results The therapeutic effects in aprotinin treating group(14.5±4.3, 19.0±5.2, 24.0±5.0, respectively) were significantly higher than those in control group(12.7±3.8, 16.8±4.8, 21.7±5.4, respectively).The producing of edema per day (0.212±0.064) in aprotinin treating group was significantly less than that in the control group(0.240±0.063). While the APTT after treatment was significantly longer ((1.2±1.8)s vs (0.4±1.8)s). Conclusions Aprotinin might inhibit the formation of cerebral edema and improve the neurologic function marks after attacks. It should be in treatment better to use aprotinin simultaneously than to use mannitol only. The mechanism properly shown is the preventive effects on bradykinin and thrombin.

关 键 词：抑肽酶 脑水肿 脑出血 对照组 治疗组 神经功能评分 作用机制 激肽释放酶 拮抗作用 变化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]