【摘要】 目的观察前列地尔注射液联合尼莫地平注射液对动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者血管内皮、炎症因子及认知功能的影响。方法 85例动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者按照随机数字表法分为对照组42例和试验组43例。对照组在常规治疗基础上静脉滴注前列地尔注射液10μg,加入0.9%Na Cl 100 m L,每天1次;试验组在对照组的基础上静脉滴注尼莫地平注射液50 m L,加入0.9%Na Cl 250 m L,每天1次。2组均治疗14 d。治疗后,观察2组患者的临床疗效,测定患者血浆降钙素基因相关肽（CGRP）和内皮素-1（ET-1）的含量,检测血清血管内皮生长因子（VEGF）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）及超敏C反应蛋白（hs-CRP）水平,用蒙特利尔认知评估量表（MOCA）评估认知功能。结果试验组的总有效率为90.70%（39/43例）,对照组的总有效率为73.81%（31/42例,P<0.05）。试验组CGRP为（55.56±8.44）pg·m L^-1,VEGF为（123.35±34.83）ng·m L^-1;对照组CGRP为（47.29±8.49）pg·m L^-1,VEGF为（142.38±14.47）ng·m L^-1（P<0.05）。试验组ET-1为（71.35±10.46）pg·m L^-1,对照组ET-1为（91.81±11.70）pg·m L^-1,2组差异有统计学意义（P<0.05）。试验组TNF-α为（0.24±0.08）ng·m L^-1,IL-8为（1.39±0.31）ng·m L^-1,hs-CRP为（189.51±23.27）ng·m L^-1;对照组TNF-α为（0.32±0.10）ng·m L^-1,IL-8为（2.24±0.34）ng·m L^-1,hs-CRP为（211.51±25.51）ng·m L^-1,2组差异有统计学意义（P<0.05）。2组药物不良反应主要为胃肠道反应、恶心呕吐、头晕头痛、皮疹,试验组药物不良反应发生率为25.58%（11/43例）,对照组为26.19%（11/42例）,差异无统计学意义（P>0.05）。结论前列地尔联合尼莫地平可改善动脉瘤性蛛网膜下腔出血伴脑血管痉挛患者血管内皮功能,降低炎症反应,增强认知功能,有良好的临床疗效。更多还原

【Abstract】 Objective To explore the influence of alprostadil combined with nimodipine to vascular endothelium,inflammatory factors and cognitive function in patients with cerebral vasospasm following aneurismal subarachnoid hemorrhage.Methods Eighty-five patients with cerebral vasospasm following aneurismal subarachnoid hemorrhage were divided into control group（ n = 42） and treatment group（ n = 43）.Control group was treated with alprostadil injection 10 μg,added to 0.9% Na Cl 100 m L intravenous drip,qd on the basis of conventional treatment.Treatment group was given nimodipine injection 50 m L,adding 0.9% Na Cl 250 m L,intravenous drip on the basis of control group,qd.All patients were treated for 14 d.The clinical effect was observed after treatment.The serum levels of calcitonin gene-related peptide（ CGRP） and endothelin 1 were tested.The levels of vascular endothelial growth factor（ VEGF）,tumor necrosis factor-α（ TNF-α）,interleukin-8（ IL-8） and hypersensitive C-reactive protein（ hs-CRP） were detected.The cognitive function was assessed by the Montreal cognitive assessment（ MOCA） scale.Results The total effective rate of treatment group was 90.70%（ 39/43）,had significant difference with 73.81%（ 31/42） in control group（ P < 0.05）.The levels of CGRP and VEGF were（ 55.56 ± 8.44） pg · m L^-1,（ 123.35 ± 34.83） ng · m L^-1in treatment group,had significant difference with（ 47.29 ± 8.49） pg · m L^-1,（ 142.38 ± 14.47） ng · m L^-1in control group（ P < 0.05）.The level of ET-1 in treatment group was（ 71.35 ± 10.46） pg·m L^-1,had significant difference with（ 91.81 ± 11.70） pg·m L^-1in control group（ P < 0.05）.The levels of TNF-α,IL-8 and hs-CRP were（ 0.24 ± 0.08）,（ 1.39 ± 0.31）,（ 189.51 ± 23.27） ng · m L^-1in treatment group,had significant difference with（ 0.32 ± 0.10）,（ 2.24 ± 0.34）,（ 211.51 ± 25.51） ng·m L^-1in control group（ P < 0.05）.The adverse drug reactions were mainly gastrointestinal reaction,nausea,vomiting,dizziness,headache,rash,and the incidence of adverse drug reactions in treatment groups was 25.58%（ 11/43）,had no significant difference with 26.19%（ 11/42） in control group（ P > 0.05）.Conclusion Alprostadil combined with nimodipine can improve endothelial function,reduce inflammatory reaction,enhance cognitive function in patients with cerebral vasospasm following aneurismal subarachnoid hemorrhage.更多还原