醒脑静注射液联合丁苯酞胶囊预防颈动脉内膜切除术后脑高灌注综合征疗效及对缺血再灌注损伤的影响  

Curative effect of Xingnaojing injection combined with butylphthalide capsules in preventing cerebral hyperperfusion syndrome after carotid endarterectomy and its effect on ischemia-reperfusion injury

作　　者：张博[1] 吴琼[2] 焦保华[2] ZHANG Bo;WU Qiong;JIAO Baohua(The First Hospital of Shijiazhuang, Shijiazhuang 050011, Hebei, China;The Second Hospital of Hebei Medical University, Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北省石家庄市第一医院,河北石家庄050011 [2]河北医科大学第二医院,河北石家庄050000

出　　处：《现代中西医结合杂志》2020年第13期1410-1414,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察醒脑静注射液联合丁苯酞胶囊预防颈动脉内膜切除术(CEA)后脑高灌注综合征(CHS)的疗效及对缺血再灌注损伤的影响。方法将2016年1月—2019年1月在石家庄市第一医院及河北医科大学第二医院择期行CEA的76例患者随机分为2组,每组38例,2组给予常规围术期处理,对照组同时于术前3 d开始给予丁苯酞胶囊治疗,观察组给予醒脑静注射液联合丁苯酞胶囊治疗,均用至术后7 d。记录2组动脉夹闭前、动脉开放后、术后3 d、术后7 d脑氧代谢指标、大脑中动脉(MCA)收缩期血流峰值速度(PSV)、炎性细胞因子和氧化应激指标,统计2组CAE术后CHS发生率。结果观察组CEA术后CHS发生率(7.89%)显著低于对照组(18.42%)(P<0.05);2组动脉开放后、术后3 d颈内静脉氧饱和度[Sjv(O2)]较动脉夹闭前显著降低(P均<0.05),观察组Sjv(O2)在术后7 d恢复正常,对照组在术后7 d仍显著低于动脉夹闭前(P<0.05);2组颈动静脉氧含量差值(Ca-jvO2)水平变化趋势与Sjv(O2)相反,观察组动脉开放后、术后3 d、术后7 d Sjv(O2)均显著高于对照组(P<0.05),而Ca-jvO2显著低于对照组(P<0.05)。2组动脉开放后、术后3 d PSV较动脉夹闭前显著升高(P均<0.05),观察组PSV在术后7 d基本恢复正常,对照组在术后7 d仍显著高于动脉夹闭前(P<0.05),观察组动脉开放后、术后3 d、术后7 d PSV均显著低于对照组(P<0.05);观察组动脉开放后、术后3 d、术后7 d脑血流速度增加比例均显著低于对照组(P均<0.05)。2组动脉开放后、术后3 d血清IL-6、TNF-α、MDA较动脉夹闭前显著升高(P均<0.05),观察组以上指标在术后7 d恢复正常,对照组在术后7 d仍显著高于动脉夹闭前(P<0.05)。2组SOD变化趋势与以上指标相反;观察组动脉开放后、术后3 d、术后7 d IL-6、TNF-α、MDA均显著低于对照组(P均<0.05),而SOD显著高于对照组(P<0.05)。结论醒脑静注射液联合丁苯酞胶囊可促进脑氧供需代谢平衡,维�Objective It is to observe the efficacy of Xingnaojing injection combined with butylphthalide capsules in preventing cerebral hyperperfusion syndrome(CHS)after carotid endarterectomy(CEA)and its effect on ischemia-reperfusion injury.Methods 76 patients who underwent CEA in the First Hospital of Shijiazhuang and the Second Hospital of Hebei Medical University from January 2016 to January 2019 were randomly divided into 2 groups,38 cases in each group.Both groups were given routine perioperative treatment.At the same time,the control group was given butylphthalide capsules at 3 days before surgery,and the observation group was treated with Xingnaojing injection combined with butylphthalide capsules,the treatments were not stopped until 7 days after surgery.The cerebral oxygen metabolism indexes,peak velocity of systolic blood flow(PSV)of middle cerebral artery,inflammatory cytokines and oxidative stress indicators before artery oeclusion,after artery opening,3 and 7 days after surgery were recorded in the two groups,the incidence of CHS after CEA was calculated.Results The incidence of CHS(7.89%)in the observation group after CEA was significantly lower than that in the control group(18.42%)(P<0.05);Sjv(O2)after artery opening,3 and 7 days after surgery was significantly lower than that before artery oeclusion in the two groups(P<0.05),it returned to normal at 7 days after surgery in the observation group,but it was still significantly lower than that before arterial oeclusion in the control group(P<0.05).The change trend of Ca-jvO2 level in the 2 groups was opposite to that of Sjv(O2).After artery opening and 3 days and 7 days after surgery,Sjv(O2)was significantly higher while Ca-jvO2 was significantly lower in the observation group than that in the control group(P<0.05).The PSV of the two groups was significantly higher after arterial opening and 3 days after operation than that before arterial oeclusion(P<0.05),it returned to normal at 7 days after surgery in the observation group,but it was still significantly

关 键 词：醒脑静注射液 丁苯酞胶囊 颈动脉内膜切除术 脑高灌注综合征 缺血再灌注损伤 脑氧代谢 脑血流动力学 

分 类 号：R653[医药卫生—外科学]