螺内酯对缺血性脑卒中患者脑血管微栓子信号、卒中复发及预后的影响  

Effect of spironolactone on cerebrovascular microembolic signal,stroke recurrence and prognosis in patients with ischemic cerebral stroke

作　　者：王亮亮[1] 周永[2] 朱向阳[2] 董政协[2] 黄怀宇[2] 汪芳[3] 王慧俐[3] 

机构地区：[1]宜兴市人民医院神经内科,214200 [2]南通大学第二附属医院神经内科 [3]南通大学第二附属医院TCD室

出　　处：《临床神经病学杂志》2013年第2期130-132,共3页Journal of Clinical Neurology

基　　金：南通市社会发展科技计划(S2008014)

摘　　要：目的研究螺内酯对缺血性脑卒中患者的脑血管微栓子信号(MES)、卒中复发及预后的影响。方法将93例经颅多普勒(TCD)检测MES阳性的缺血性脑卒中患者随机分为常规治疗组(常规组,46例)及螺内酯治疗组(螺内酯组,47例)。常规组给予肠溶阿司匹林、阿托伐他汀治疗;螺内酯组在常规组治疗基础上予螺内酯20 mg/d,连续用6个月。在治疗3个月、6个月时,用TCD仪检测患者双侧大脑中动脉的MES。在治疗6个月后,用美国国立卫生研究院卒中量表、改良Rankin量表和Barthel指数评定患者的预后;统计两组死亡、缺血性脑卒中复发和预后良好的例数。结果治疗3个月和6个月时,螺内酯组的MES阳性率(46.8%,36.2%)显著低于常规组(70.5%,61.4%)(均P<0.05);治疗6个月后,两组患者死亡、缺血性脑卒中复发和预后良好的比率比较差异无统计学意义。结论螺内酯可以明显降低缺血性脑卒中患者的脑血管MES阳性率,但对缺血性脑卒中的复发及神经功能恢复无明显影响。Objective To research the effect of spironolactone on cerebrovascular microembolic signal（MES）, stroke recurrence and prognosis in patients with ischemic cerebral stroke. Methods Ninety three ischemic stroke patients of MES positive detected by transcranial Doppler （TCD） were randomly divided into the conventional therapy group （conventional group, 46 cases ） and spironolactone treatment group （spironolaetone group, 47 cases ）. The patients in conventional group were given with aspirin and Atorvastatin therapy. Besides the treatments in conventional group, the patients in spironolactone group were recieved 20 mg of spironolactone per day, consecutive six months. At the treatment of 3 months and 6 months, the MES detection in patients with bilateral middle cerebral artery using TCD instrument. After 6 months of treatment, the prognosis of patients was evaluated with National institutes of health stroke scale, modified Rankin scale and Barthel index; and the cases of death, ischemic stroke recurrence, good prognosis in two groups were statistics. Results After treatment for 3 months and 6 months, the MES positive rates （46.8% , 36. 2% ） of spironolactone group were significantly lower than of conventional group（70. 5% ,61.4% ） （ all P 〈 0. 05 ）. The rates of death, ischemic stroke recurrence and good prognosis in two groups had no significant differences. Conclusion Spironolactone can significantly reduce the rates of cerebrovascular MES positive, but it has no significant effect on isehemic stroke recurrence and neurological function recovery in the patients with ischemic cerebral stroke.

关 键 词：缺血性脑卒中 脑血管 微栓子信号 螺内酯 脑卒中复发 

分 类 号：R743.3[医药卫生—神经病学与精神病学]