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目的观察自由基清除剂依达拉奉对动脉瘤性蛛网膜下腔出血(aneurysmal subarachoid hemorrhage,aSAH)后迟发性脑血管痉挛(delayed cerebrovascular spasm,DCVS)的防治作用。方法58例aSAH患者随机分成两组,对照组(n=29):常规治疗加尼莫地平1~2 mg/h持续泵入连用14天。治疗组(n=29):在对照组治疗基础上同时应用依达拉奉30 mg入液静脉滴注,2次/d,连用14天。所有患者于治疗后第1、3、7、14天检测血清中S-100B蛋白浓度。经颅多普勒(TCD)检测大脑中动脉(MCA)血流速度。比较治疗前后两组预后评分并进行统计学分析。结果总体病情格拉斯哥昏迷评分(GCS)、Hunt-Hess分级及Fisher分级治疗前两组差异无统计学意义(P>0.05)。两组的MCA血流速度和S-100B含量在组间、不同时点以及在组间和不同时点的交互作用中差异均有统计学意义(P=0.000),两组MCA血流速度在第7天最快、S-100B含量在第7天最高,均到第14天下降,治疗组总的趋势低于对照组。治疗组的临床疗效优于对照组(P=0.031)。结论依达拉奉可有效的降低氧自由基水平,缓解迟发性脑血管痉挛。
Objective To observe the preventive and therapeutic effects of free radical scavenger edaravone on delayed cerebrovascular spasm (DCVS) after aneurysmal subarachoid hemorrhage (aSAH). Methods 58 patients with aSAH were randomly divided into two groups, the control group (n = 29): routine treatment of nimodipine 1 ~ 2 mg / h continuous infusion for 14 days. Treatment group (n = 29): On the basis of the control group, edaravone 30 mg intravenous infusion was given twice a day for 14 days. All patients on the 1st, 3rd, 7th and 14th day after treatment detected the serum concentration of S-100B protein. Transcranial Doppler (TCD) was used to detect the blood flow velocity of middle cerebral artery (MCA). The prognosis scores of two groups before and after treatment were compared and statistically analyzed. Results The overall incidence of Glasgow Coma Scale (GCS), Hunt-Hess classification and Fisher classification before treatment was no significant difference between the two groups (P> 0.05). The MCA blood flow velocity and the content of S-100B in two groups were significantly different (P = 0.000), between groups and at different time points and in the interaction between groups The fastest on day 7, the content of S-100B was the highest on the 7th day and all decreased on the 14th day. The overall trend of the treatment group was lower than that of the control group. The clinical efficacy of treatment group than the control group (P = 0.031). Conclusion Edaravone can effectively reduce the level of oxygen free radicals and relieve delayed cerebral vasospasm.