标题：吡拉西坦联合脑苷肌肽治疗急性脑出血伴脑水肿疗效观察

      作者：刘玉娟，房卫，孙建忠    鄄城县人民医院神经内科，山东 鄄城 274600

      卷次： 2019年30卷7期

      【摘要】 目的 分析吡拉西坦联合脑苷肌肽治疗急性脑出血伴脑水肿患者的近、远期临床疗效。方法 回顾性分析2016年8月至2017年8月于鄄城县人民医院接受治疗的120例急性脑出血伴脑水肿患者的临床资料，所有患者均行相应手术治疗，根据药物治疗方案的不同将患者分为对照组48例和联合组72例。对照组患者单用吡拉西坦治疗，联合组患者在对照组的基础上加用脑苷肌肽联合治疗，疗程共两周。两组患者于连续用药两周后比较治疗前后神经功能缺损程度评分(NIHSS)、简易智力状态检查量表(MMSE)、日常生活能力量表(ADL)和蒙特利尔认知评估量表(MoCA)；比较两组患者治疗后神经源性营养因子(BDNF)、单核细胞趋化蛋白-1 (MCP-1)和血清血清神经元特异性烯醇化酶(NSE)水平和治愈后 1年内死亡率。结果 两组患者治疗后的NIHSS、MMSE、ADL和MoCA评分均较治疗前明显升高，且联合组4项评分均显著优于对照组，差异均有统计学意义(P<0.05)；联合组患者的临床治疗总有效率为 93.44%，明显高于对照组的 81.25%，差异有统计学意义(P<0.05)；两组患者治疗后BDNF、MCP-1和NSE水平均较治疗前明显改善，其中BDNF水平较治疗前有所升高，但MCP-1和NSE水平较之前有所下降，且联合组的BDNF、MCP-1和NSE水平改善程度均明显优于对照组，差异均有统计学意义(P<0.05)；联合组患者治愈后1年内死亡率为2.78%，明显低于对照组的12.50%，差异有统计学意义(P<0.05)。结论 与单用吡拉西坦治疗比较，吡拉西坦和脑苷肌肽联合治疗急性脑出血伴脑水肿改善患者的神经功能和认知功能更明显，临床疗效更显著，且治愈后1年内死亡率更低，值得临床推广使用。
      【关键词】 吡拉西坦；脑苷肌肽；急性脑出血；脑水肿；联合治疗；细胞因子；神经功能；认知功能
      【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1003—6350（2019）07—0839—04

Curative effect of piracetam combined with cattle encephalon glycoside and ignotin injection in the treatment ofacute cerebral hemorrhage with cerebral edema.
LIU Yu-juan, FANG Wei, SUN Jian-zhong. Department of Neurology,Juancheng County People's Hospital, Juancheng 274600, Shandong, CHINA
【Abstract】 Objective To analyze the curative effect of piracetam combined with cattle encephalon glycosideand ignotin injection on acute cerebral hemorrhage and cerebral edema. Methods The clinical data of 120 patients withacute cerebral hemorrhage and cerebral edema treated in Yucheng County People's Hospital from August 2016 to August2017 were retrospectively analyzed. All the patients underwent surgical treatment and were divided into 48 patients inthe control group and 72 patients in the combined group according to different drug treatment options. The patients in thecontrol group were treated with piracetam alone, while patients in the combined group were treated with cattle encepha-lon glycoside and ignotin injection combined on the basis of the treatment of the control group. The changes of neurolog-ical deficits (NIHSS), simple mental status examination scale (MMSE), daily life ability scale (ADL) and Montreal cogni-tive evaluation scale (MoCA) and serological indicators were compared in the two groups, and The levels of brain-derivedneurotrophic factor (BDNF), monocyte chemoattractant protein-1 (MCP-1) and serum neuron-specific enolase (NSE) aftertreatment and mortality within one year after treatment were compared between the two groups. Results The NIHSS,MMSE, ADL and MoCA scores of the two groups after treatment were significantly higher than those before treatment,and the four scores of the combined group were significantly better than those of the control group (P<0.05). The total ef-fective rate of the combined group was 93.44%, which was significantly higher than 81.25% of the control group (P<0.05). The levels of BDNF, MCP-1, and serum NSE in the combined group were significantly better than those in thecontrol group (P<0.05), and the mortality rate in the combined group was 2.78% within one year after cure, which wassignificantly lower than 12.50% in the control group (P<0.05). Conclusion Compared with piracetam alone, the combi-nation of piracetam and cattle encephalon glycoside and ignotin injection on patients with acute cerebral hemorrhage andcerebral edema with piracetam is more effective in improving neurological and cognitive functions, which has a moresignificant clinical effect. Moreover, the mortality rate is lower within one year after curing. It has a good reference valuein clinic and is worthy of further promotion.
      【Key words】 Piracetam; Cattle encephalon glycoside and ignotin injection; Acute cerebral hemorrhage; Brainedema; Combined therapy; Cytokines; Neurological function; Cognitive function