不同劑量納絡酮治療腦出血對患者神經(jīng)元保護的作用

1、不同劑量納絡酮治療腦出血對患者神經(jīng)元保護的作用         07-08-28 11:12:00     作者：劉大建，劉森     編輯：studa20【關(guān)鍵詞】  腦出血    Study on neuronprotective effect of different doses of naloxone in patients with intracerebral hemorrhage【Ab

2、stract】 AIM: To explore the doseeffect relationship of neuronprotective effect of different doses of  naloxone in patients with intracerebral hemorrhage. METHODS:  One hundred and twenty patients were randomly divided into 3 groups of 40 cases each: high dose (H), medium dose (M) and low d

3、ose (L) groups. The hematoma volume and edemazone areas, the level of neuron specific enolase (NSE) in serum, nervefunctiondefect score and the ADL score were examined at particular time respectively. RESULTS:  There were significant differences in the hematoma volume and edemazone area at diff

4、erent times points within a group (P0.001). However, among different groups, the hematoma volume of L group was larger than those of H and M groups at 10 d (P<0.001) and the edemazone area of L group was larger than that of M and H groups（P0.002). But at 20 d, there was no significant difference

5、in the hematoma volume and edemazone area among the 3 groups. There was an increase of NSE in serum at 12 h after hemorrhage in all the patients. Moreover, NSE significantly decreased at 20 d and there were significant differences among the groups. The level of NSE in H group was lower than that in

6、M group and that in M group was lower than that in L group（P<0.001）. The nervefunctiondefect scores of H group was higher than those of M group and L group at 20 d（P<0.02）. The ADL scores of H group was higher than that of M group and the score of M group was higher than that of L group at 3 m

7、o（P<0.001）. CONCLUSION:  Therapy with naloxone of 0.3 mg/(kgd) each day can protect neurons, decrease the function defect and improve living conditions in patients with intracerebral hemorrhage.【Keywords】 cerebral hemorrhage; Naloxone; doseresponse relationship, drug;  phosphopyruvate h

8、ydratase【摘要】 目的： 探討不同劑量納絡酮治療腦出血對其神經(jīng)功能保護作用的量效關(guān)系. 方法： 腦出血患者120例，隨機分為納絡酮高(H)、中(M)、低(L）劑量治療組，每組40例，分期測患者血腫體積和水腫帶面積、血清神經(jīng)元特異性烯醇化酶(NSE)水平，進行神經(jīng)缺損及ADL評定. 結(jié)果： 資料完整患者H組32例、M組29例、L組34例.  3組組內(nèi)血腫體積和水腫帶面積隨時間變化有差異(P<0.001)；組間比10 d時血腫體積L組明顯>M組>H組(P<0.001)，水腫帶面積L組>M組>H組（P0.002)，但20 d組間血腫體積及水腫帶面

9、積均無差異； 出血后12 h內(nèi)患者血清NSE升高，20 d時明顯下降且組間比NSE值有差異（P<0.001），明顯H組<M組<M組<L組（PM組>L組（P<0.001）. 結(jié)論： 0.3 mg/（kgd）納絡酮治療具有更良好的保護患者神經(jīng)元、降低功能缺損、提高預后生活質(zhì)量的作用. 【關(guān)鍵詞】 腦出血；納絡酮；劑量效應關(guān)系，藥物；磷酸丙酮酸水合酶0引言腦出血是一種致殘率極高的疾病，血腫及繼發(fā)缺血導致的神經(jīng)功能缺損給患者生活帶來極大的痛苦，保護神經(jīng)細胞是早期治療不可忽視的環(huán)節(jié). 近年發(fā)現(xiàn)納絡酮還具有非拮抗阿片受體作用，對穩(wěn)定腦出血后神經(jīng)元有一定的作用，

10、但目前還缺乏納絡酮的推薦劑量及相關(guān)實驗支持1. 神經(jīng)元特異性烯醇化酶(neuron specific enolase, NSE)是神經(jīng)系統(tǒng)特異性蛋白質(zhì)，主要存在于大腦神經(jīng)元和神經(jīng)內(nèi)分泌細胞內(nèi)，當其損傷或壞死后，NSE可溢入腦脊液和血液；腦膠質(zhì)細胞和其他神經(jīng)組織不含NSE，故它是檢測腦中神經(jīng)元壞死的客觀指標2，3. 所以我們以不同劑量納絡酮早期治療腦出血，通過血清NSE的檢測和功能缺損等評定，評價納絡酮的量效關(guān)系.1對象和方法1.1對象200204/200404本院患者120例. 診斷依據(jù)第四屆全國腦血管病會議修訂標準，發(fā)病12 h內(nèi)入院，螺旋CT診斷為基底節(jié)區(qū)出血，出血量在1040 mL，排除

11、嚴重心肝腎疾病患者. 依入院順序隨機分為納絡酮高(H)、中(M)、低(L)劑量治療組，每組40例. 除2例死亡、7例再出血轉(zhuǎn)外科治療、16例退出研究外，最終三組一般情況如Tab 1所示，組間年齡、性別、出血量差異無統(tǒng)計學意義. 表1三劑量組腦出血患者一般情況比較（略）1.2方法1.2.1藥物治療各組均給甘露醇降顱壓、常規(guī)腦細胞代謝劑等. 在此基礎上，于入院當日給納絡酮，H組0.3 mg/(kgd), M組0.15 mg/(kgd), L組0.08 mg/(kgd)，前3 d以NS  100 mL稀釋后，用輸液泵24 h持續(xù)滴注；后12 d用 100 mL NS稀釋后靜滴.1.2.2觀察指標 于入院時,10 d, 20 d行螺旋CT檢查，計算血腫體積（多式田法）及水腫帶面積. 于入院12 h, 5 d, 10 d, 20 d抽血測血漿NSE(晨起空腹抽血1 mL，分離血清，-30