丁苯酞在促进缺血性烟雾病颅内外血运重建术后神经功能恢复的回顾性研究  

A retrospective study of Dl-3-N-butylphthalide(NBP)for promoting recovery of neurological deficits after intracranial revascularization for moyamoya disease

作　　者：王毅[1] 陈鑫华 许天助 周璐 吴凌云 戴嵬 杨咏波[1] 黄斌[2] WANG Yi;CHEN Xin-hua;XU Tian-zhu(Department of Neurosurgery,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008 [2]南京大学医学院附属鼓楼医院肿瘤科,南京210008

出　　处：《临床神经外科杂志》2022年第4期372-376,共5页Journal of Clinical Neurosurgery

基　　金：江苏省科技计划面上项目(BE2016808)。

摘　　要：目的研究及评估丁苯酞(NBP)软胶囊对于烟雾病患者围手术期脑卒中以及神经功能恢复的临床作用。方法回顾性分析南京大学医学院附属鼓楼医院神经外科2018年1月—2019年8月收治的符合入组条件的101例患者(121次进行了颅内外血运重建手术的半球)的缺血性烟雾病患者,其中43例患者术后接受了90 d的NBP序贯治疗。根据发病类型和术前神经系统状态进行亚组分析,以确定可能受益于NBP的患者的具体特征。结果在整个队列中,接受NBP治疗的患者和未接受NBP治疗的患者在术前脑卒中和改良Rankin量表(mRS)评分方面基线特征不同。两组病例术后发生卒中11例,发生TND 21例,两组发生率无显著差异。然而,NBP治疗组的TND较治疗组轻(P=0.01)。术后1个月,NBP患者的神经预后较好(P=0.001),无残疾恢复率较高(P<0.001)。经mRS测量,与术前相比,神经功能得到改善的患者数量在NBP组要大于无NBP组(P<0.001)。多变量分析显示,NBP与TND严重程度降低(OR 0.28,P=0.02)、神经功能改善(OR 65.29,P=0.04)和术后mRS评分降低(OR 0.06,P<0.001)相关。NBP的这些有益作用在缺血性烟雾病患者和术前mRS评分为2分或更高的患者中仍然是显著的。治疗组患者治疗2周后、治疗1个月后神经功能缺损评分均明显优于对照组(P<0.05);治疗组治疗1个月后、治疗3个月后生活质量评分均明显优于对照组(P<0.05)。结论NBP软胶囊对烟雾病围手术期神经功能缺损患者的恢复存在积极作用,可提升患者生活自理能力,值得临床推广应用。Objective To study and evaluate the clinical effects of Dl-3-N-butylphthalide(NBP)soft capsule on perioperative stroke and neurological function recovery in patients with moyamoya disease(MMD).Methods 101 patients(121 hemispheres underwent STA-MCA revascularization)with ischemic MMD who were admitted to the Department of Neurosurgery of Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2018 to August 2019 were analyzed retrospectively.43 cases of them received 90 days of NBP treatment after surgery.A subgroup analysis was performed based on the type of disease and preoperative nervous system status to determine the specific characteristics of patients who may benefit from NBP.Results Baseline characteristics were different in preoperative stroke and modified Rankin scale(mRS)scores for patients treated with NBP and those not treated with NBP throughout the cohort.There were 11 cases of postoperative stroke and 21 cases of TND between the two groups,and there was no significant difference in incidence between the two groups.However,TND in the NBP group was less severethan that in the treatment group(P=0.01).One month after the operation,NBP patients had a better neurological prognosis(P=0.001)and a higher disableless recovery rate(P&LT;0.001).As measured by mRS,the number of patients with improved neurological function was greater in the NBP group than in the NBP group(P&LT;0.001).Multivariate analysis revealed reduced NBP and TND severity(OR 0.28,P=0.02),improved neurological function(OR 65.29,P=0.04),and decreased postoperative mRS score(OR 0.06,P&LT;0.001).These beneficial effects of NBP remained significant in patients with ischemic MMD and in patients with a preoperative mRS score of 2 or higher.The scores of nerve function defect in the treatment group were significantly better than those in the control group after 2 weeks and 1 month(P&LT;0.05).The quality of life scores of the treatment group after 1 month of treatment and 3 months of treatment were significantly better than

关 键 词：烟雾病 脑卒中 丁苯酞胶囊 神经功能损害 

分 类 号：R651[医药卫生—外科学]