丁苯酞注射液对动脉瘤性蛛网膜下腔出血早期脑损伤的作用与机制探讨  

Effect and Mechanism of Butyphthalide Injection on Early Brain Injury in Aneurysmal Subarachnoid Hemorrhage

作　　者：刘昌亚 胡学斌 熊志勇 郑津 刘杨 姚凡 LIU Chang-Ya;HU Xue-Bin;XIONG Zhi-Yong;ZHENG Jin;LIU Yang;YAO Fan(Department of Neurology,Hubei Provincial Hospital of TCM,Wuhan 430061,China;Department of Neurosurgety,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]湖北省中医院神经内科,武汉430061 [2]华中科技大学同济医学院附属协和医院神经外科

出　　处：《中国卒中杂志》2018年第7期692-695,共4页Chinese Journal of Stroke

摘　　要：目的探讨丁苯酞注射液对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhages,aSAH)患者早期脑损伤的作用与机制。方法收集2017年8月-12月期间急性发病的aSAH患者66例,均在动脉瘤破裂后予以介入栓塞术治疗。入组患者随机分为观察组、对照组各33例。对照组术后常规药物及对症支持治疗,观察组在常规治疗的基础上加用丁苯酞注射液,100 ml,Q12 h,静脉滴注,两组病例均连续治疗7 d。分别于发病1 d、3 d和7 d测定患者血清一氧化碳(nitric oxide,NO)、血清内皮素血管肽-1(endothelin-1,ET-1)、血清神经特异性烯醇酶(neuron specific enolase,NSE)、血清C反应蛋白(C-reactive protein,CRP)、血清细胞内黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、血清白细胞介素-1β(Interleukin-1,IL-1β)的水平,并且在发病第4周记录两组患者迟发性脑梗死的发生情况,改良Rankin评分量表的评分。结果观察组发病3 d、7 d的血清NO水平高于对照组,3 d、7 d血清ET-1、NSE、CRP、ICAM-1、IL-1β的水平低于对照组,差异均具有统计学意义。发病4周观察组改良Rankin评分量表≤2分的比例高于对照组,差异具有统计学意义。两组迟发性脑梗死发生无显著差异。结论 aSAH后使用丁苯酞注射液能够降低与早期脑损伤相关的炎性因子水平,改善此类患者的预后。Objective To investigate the effect and mechanism of Butyphthalide injection on early brain injury in patients with aneurysmal subarachnoid hemorrhages（aSAH）.Methods From August 2017 to December 2017, a total of 66 patients with acute aSAH were enrolled in the study. They were all treated by interventional embolization after aneurysm ruptured. They were randomly divided into observation group and control group, and 33 cases in each group. The control group received routine medication and symptomatic support treatment. The observation group was given intravenous Butyphthalide injection in addition, 100 ml, Q12 h. All the patients were treated continuously for 7 days. The levels of serum nitric oxide（NO）, serum endothelin-1（ET-1）, serum neuron specific enolase（NSE）, serum C reactive protein（CRP）, serum intercellular adhesion molecule-1（ICAM-1） and serum interleukin-1β（IL-1β） were determined on day 1, 3 and 7 after onset in both groups, and delayed cerebral infarction and modified Rankin scale（m RS） score were observed in all patients of two groups.Results The levels of NO in observation group were higher than that in control group on day 3 and 7, while the levels of ET-1, NSE, CRP, ICAM-1 and IL-1β were all lower than that in control group on day 3 and 7, all above had statistical difference. The rate of mR S≤2 score in observation group was higher than that in control group, with statistical significance. There was no significant difference in delayed cerebral infarction incidence between two groups.Conclusion Using Butyphthalide after aSAH can reduce early brain injury, improve the prognosis of such patients. Decreasing inflammatory factors production using Butyphthalide may play a role on amelioration of focal brain injury.

关 键 词：丁苯酞注射液 动脉瘤 蛛网膜下腔出血 早期脑损伤 

分 类 号：R743.35[医药卫生—神经病学与精神病学]