Influence of neurological intervention combined with dexamethasone injection on the outcome for the patients suffered from acute ischemic stroke
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摘要:
目的探讨神经介入联合局部使用地塞米松治疗急性缺血性脑卒中（AIS）的疗效及安全性。 方法入选60例AIS患者随机分为地塞米松组（A组）、生理盐水组（B组）及单纯介入组（C组），每组各20例。比较3组术后神经功能评分、脑组织相对表观弥散系数、内分泌及并发症例数等。 结果A组术后1月神经功能评分明显低于B及C组（P<0.05）；A组术后第3天脑组织相对表观弥散系数明显高于B及C组，而术后1月最终脑体积明显低于B及C组；术后第1天3组间血清皮质醇含量均无统计学意义(P>0.05)；3组间术后并发症例数构成均无统计学差异（P>0.05）。 结论神经介入联合局部使用地塞米松治疗可减轻AIS患者脑水肿并降低脑梗死体积，且不影响神经内分泌、不增加患者发生并发症风险，有助于改善AIS患者的预后。 Abstract:Objective To observe the influence of neurological intervention combined with dexamethasone injection on theoutcome for the patients suffered from acute ischemic stroke. Methods Sixty patients with AIS were randomly divided into thedexamethasone group (group A), normal saline group (group B) and the simple intervention group (group C), with 20 cases ineach group. Three groups were compared of postoperative neurological function score (NIHSS) scores, brain tissue relativeapparent diffusion coefficient (rADC), endocrine and complications such as the number of cases. Results NIHSS score ofgroup A was lower than that in group B and C (P<0.05) after January; A group was significantly higher than that of group Band C in postoperative day 3 rADC, and the final brain volume was lower than that in group B and C after 1 month; serumcortisol levels between the 3 groups had no significant difference (P>0.05) at postoperative day 1; The postoperativecomplications between the 3 groups of cases constitute had no significant difference (P>0.05). Conclusion Nerve involvementwith local use of DXM therapy can relieve cerebral edema and AIS patients reduced cerebral infarction volume, can not affectthe neuroendocrine, does not increase a patient's risk of complications, and help to improve the prognosis of patients with AIS. -
Key words:
- ischemic stroke /
- brain protect /
- glucocorticoids /
- nerve intervention /
- prognosis
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表 1 治疗前3 组患者基本情况(n=20, x±s)
分组 年龄(岁) 术前NIHSS评分 高血压 糖尿病 冠心病 高脂血症 高同型半胱氨酸症 A 58.2±11.4 23.9±4.6 3 2 1 2 0 B 55.2±10.5 23.7±4.4 3 0 2 3 1 C 52.4±8.4 24.6±3.9 2 1 1 4 0 F/χ2 3.21 0.22 2.79 5.62 0.70 0.84 1.85 100 P 0.57 0.80 0.27 0.52 0.28 0.50 0.60 
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表 2 术后血清皮质醇水平、rADC和最终脑梗死体积(x±s)
分组 血清皮质醇均值（nmol/L) 术后3 d rADC均值 术后1 个月最终脑梗死体积均值（mm3） A 610.9±154.9 0.62±0.1*# 7.20±2.4*# B 606.3±135.2 0.49±0.3 10.74±4.5 C 600.9±163.7 0.48±0.2 10.90±6.0 F 0.02 14.63 4.26 P 0.98 0.00 0.02 *P<0.05 vs B组; #P<0.05 vs C组
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表 3 3组患者术后1 个月内并发症情况（n）
分组 脑出血 再灌注综合症 肺部感染 消化道出血 糖尿病 A 2 2 8 1 4 B 1 3 7 2 5 对照组 3 1 9 1 3 χ2 0.72 0.72 1.12 0.70 0.68 P 0.31 0.31 0.28 0.28 0.4
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表 4 3组患者术后NIHSS评分情况(x±s)
分组 术后第1 天 术后第3 天 术后1 周 术后2 周 术后1 个月 A 18.8±3.9* 13.5±3.2*# 11.3±2.4*# 9.6±2.1*# 7.1±1.3*# B 21.1±4.6 18.1±4.3 15.7±4.1 12.8±4.2 10.2±2.9 C 21.1±3.9 17.9±3.5 15.7±3.0 12.3±3.0 9.3±3.0 F 2.1 9.76 12.56 5.93 7.61 P 0.14 0.00 0.00 0.01 0.00 *P<0.05 vs B组; #P<0.05 vs C组
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