小剂量艾司洛尔复合右美托咪定对aSAH后血管痉挛及预后的影响  

Effect of low-dose esmolol combined with dexmedetomidine on cerebralvasospasm and prognosis after aneurysmal subarachnoid hemorrhage

作　　者：秦锦标 梁冲 李翔[3] 傅传经[4] 刘高飞 朱敏 Qin Jinbiao;Liang Chong;Li Xiang;Fu Chuanjing;Lilt Gaofei;Zhu Min(Department of Neurology,the Qinhuai Medical District,Eastern Theater Command General Hospital,Nanjing 210002,China)

机构地区：[1]东部战区总医院秦淮医疗区神经内科,南京210002 [2]东部战区总医院秦淮医疗区神经外科,南京210002 [3]南京医科大学附属南京医院(南京市第一医院)神经外科 [4]江苏省中医院神经外科

出　　处：《脑与神经疾病杂志》2022年第4期220-223,共4页Journal of Brain and Nervous Diseases

基　　金：江苏省中医药局科技项目(JD201809);南京医科大学科技发展基金(NMUB2019148)。

摘　　要：目的探讨小剂量艾司洛尔复合右美托咪定(Dex)对动脉瘤性蛛网膜下腔出血(aSAH)后血管痉挛(CVS)及预后的影响。方法将东部战区总医院秦淮医疗区收治的48例aSAH患者随机分为两组,对照组(NS)组和干预组(DE组),每组24例,所有患者均接受手术治疗,检测患者术后第1d(T1)、3d(T2)、7d(T3)、14d(T4)的大脑中动脉的平均血流速度;检测血清NF-κB、VEGF、sVCAM-1及脑脊液IL-6、ET-1和NALP-1水平。采用格拉斯哥预后量表(GOS)评估患者预后。结果与T1相比,两组患者T2~T3时血清NF-κB、VEGF、sVCAM-1及脑脊液IL-6、ET-1、NALP-1水平均明显升高(P<0.05);而与NS组相比,DE组患者T2~T3时血清NF-κB、VEGF、sVCAM-1及脑脊液IL-6、ET-1和NALP-1水平均明显降低(P<0.05),重度脑血管痉挛发生率明显降低(P<0.05),且GOS明显升高(P<0.05)。结论小剂量艾司洛尔复合Dex可明显减轻aSAH后神经炎症从而减轻CVS起到脑保护作用。Objective To investigate the effect of low dose esmolol combined with dexmedetomidine(Dex)on cerebral vasospasm(CVS) and prognosis after aneurysmal subarachnoid hemorrhage(aSAH).Methods Fortyeight patients with aSAH were randomly divided into two groups:Control group(NS group) and Intervention group(DE group),24 cases in each group.Mean blood flow velocity of the middle cerebral artery on firstday(T;),3th day(T;),7thday(T;) and 14thday(T;) after surgery were detected.The levels of NF-κB,VEGF,SVCAM-1 in serum and IL-6,ET-1 and NALP-1 in cerebrospinal fluid were detected.The outcomes were assessed by the Glasgow Outcome Scale(GOS).Results Compared with T;, the levels of NF-κB,VEGF,SVCAM-1 in serum and IL-6,ET-1 and NALP-1 in cerebrospinal fluid in 2 groups were significantly increased from T;to T;(P<0.05).Compared with NS group,the levels of NF-κB,VEGF,SVCAM-1 and CEREBRO spinal fluid IL-6,ET-1 and NALP-1 in DE group were significantly decreased from T;to T;(P<0.05),the incidence of severe CVS was significantly decreased(P<0.05),and GOS was significantly increased(P<0.05).Conclusion Low dose esmolol combined with Dex can significantly reduce neuroinflammation after aSAH,thus reducing CVS and play brain protection effect.

关 键 词：艾司洛尔 右美托咪定 动脉瘤 蛛网膜下腔出血 血管痉挛 

分 类 号：R743[医药卫生—神经病学与精神病学]