3%高渗盐水抑制脑出血患者继发炎性损伤的临床研究  

3% hypertonic saline inhibits secondary inflammatory injury in patients with intracerebral hemorrhage:a clinical comparative study

作　　者：廖洪民[1] 王勇[1] 王付裕 朱家伟[1] 黄建军[1] Liao Hongmin;Wang Yong;Wang Fuyu(The Guizhou Aerospace Hospital,Zunyi,Guizhou 563003)

机构地区：[1]贵州航天医院,贵州遵义563003

出　　处：《基层医学论坛》2023年第4期1-4,共4页The Medical Forum

基　　金：遵义市科技计划项目[遵市科合HZ字(2019)215号]。

摘　　要：目的 观察3%高渗盐水(hypertonic saline,HS)对脑出血患者血清炎性因子及神经功能的影响,探讨3%HS抑制炎性损伤的脑保护作用。方法 采用随机数字表法将36例出血量15~20 m L的脑出血非手术治疗患者分为观察组和对照组,每组各18例。观察组静脉滴注3%HS(3 m L/kg),对照组静脉滴注20%甘露醇(2.5 m L/kg),给药频率为每8 h一次,疗程5 d。采用酶联免疫吸附法检测2组发病后12 h、1 d、3 d、7 d血清TNF-α、IL-1β、IL-6和IL-10水平,比较2组治疗后7 d血肿周围脑水肿体积、14 d NIHSS及90 d m RS评分。结果 2组患者发病后血清炎性因子水平均明显升高,发病12 h后的不同时间段,观察组TNF-α、IL-1β、IL-6均低于对照组,IL-10高于对照组,差异均有统计学意义(P<0.05);观察组治疗后7 d血肿周围脑水肿体积小于对照组(P<0.05);观察组治疗后14 d NIHSS评分低于对照组,但差异无统计学意义(P>0.05);随访90 d观察组m RS评分低于对照组(P<0.05)。结论 3%HS可有效抑制脑出血后TNF-α、IL-1β、IL-6释放、促进IL-10表达,减轻血肿周围脑水肿,对改善患者预后有益。Objective To observe the effects of 3% hypertonic saline(HS)on serum inflammatory factors and neurological function in patients with intracerebral hemorrhage,and to explore the brain protective effect on inflammatory injury.Methods Using prospective randomized control method,36 patients with intracerebral hemorrhage with bleeding volume of15~20 m L were randomly divided into observation group and control group,with 18 cases in each group.The observation group was intravenously injected with 3% HS(3 m L/kg)and the control group was intravenously injected with 20% mannitol(2.5 m L/kg).The administration frequency was once every 8 h for 5 days.The concentration of TNF-α、IL-1β、IL-6 and IL-10 in serum were detected by enzyme-linked immunosorbent assay at 12 h,1 d,3 d and 7 d after onset.The volume of brain edema around hematoma,NIHSS score at 14 days and m RS score at 90 days were compared. Results The serum inflammatory factor concentrations in the two groups were significantly increased after the onset.Other different time periods except 12 hours of onset,the concentrations of TNF-α,IL-1β,and IL-6 in the observation group were lower than those in the control group(P<0.05),and the concentration of IL-10 in the observation group was higher than that in the control group(P<0.05).The volume of brain edema around the hematoma was smaller than that of the control group at 7 days(P<0.05);NIHSS score of the observation group was lower than that of the control group at 14 days,but the difference was not statistically significant(P>0.05);After 90 days of follow-up,the m RS score of the observation group was lower than that of the control group(P<0.05).Conclusions 3% HS can effectively inhibit the release of TNF-α,IL-1β,IL-6 after cerebral hemorrhage,promote the expression of IL-10,reduce the brain edema,and be beneficial to improve the prognosis of patients.

关 键 词：脑出血 高渗盐水 炎症因子 脑水肿 白细胞介素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]