Clinical study of minimally invasive puncture and drainage combined with piracetam and urapidil in the treatment of hypertensive intracerebral hemorrhage in basal ganglia

doi:10.3877/cma.j.issn.2095-123X.2023.05.004

Abstract

Abstract:

Objective

To investigate the clinical efficacy of minimally invasive puncture and drainage combined with pilacetan and urapidil in the treatment of hypertensive intracerebral hemorrhage (HICH) in the basal ganglia and its effects on the levels of serum markers of brain injury, matrix metalloproteinases (MMPs), interleukin-1β (IL-1β) and high mobility group protein B1 (HMGB1).

Methods

Eighty-six patients with HICH in basal ganglia region admitted to the Neurosurgery Department of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2019 to December 2021 were randomly divided into a control group and an observation group, with 43 patients in each group. The control group was treated with minimally invasive puncture and drainage combined with urapidil, and the observation group was treated with piracetam based on the control group. After 14 d of continuous treatment, the clinical efficacy of the two groups was compared. The National Institutes of Health stroke scale (NIHSS) score was used to evaluate the neurological function of the subjects before and after treatment, GCS score was used to evaluate the consciousness status of the subjects, and mini-mental state examination (MMSE) was used to evaluate the cognitive function of the patients. Serum brain injury markers [GFAP, neuron-specific enolase (NSE), S100β], MMPs (MMP-2, MMP-3, MMP-9), IL-1β and HMGB1 were detected by enzyme-linked immunoassay before and after treatment. The adverse drug reactions of the two groups were recorded.

Results

The total effective rate of the observation group was 90.70% (39/43), which was significantly higher than that of the control group [74.42% (32/43)] (P<0.05). After treatment, NIHSS score and levels of serum NSE, GFAP, S100β protein, MMP-2, MMP-3, MMP-9, IL-1β and HMGB1 were significantly lower than before treatment, and GCS and MMSE scores were significantly higher than before treatment, and the changes were more significant in observation group (P<0.05). There was no obvious drug side reaction in all subjects.

Conclusion

Minimally invasive puncture and drainage combined with piracetam and urapidil in the treatment of BASAL ganglia HICH can safely and effectively reduce the levels of serum markers of brain injury, MMPs, IL-1β and HMGB1, promote the relief of inflammatory response, and alleviate neurological deficits.

Key words: Minimally invasive puncture drainage, Piracetam, Urapidil, Hypertensive intracerebral hemorrhage, Markers of brain injury, Matrix metalloproteinases

Mo Yun, Maofang Li, Hao Wang, Dongyuan Liu. Clinical study of minimally invasive puncture and drainage combined with piracetam and urapidil in the treatment of hypertensive intracerebral hemorrhage in basal ganglia[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(05): 278-285.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnkjbykfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-123X.2023.05.004

https://zhnkjbykfzz.cma-cmc.com.cn/EN/Y2023/V13/I05/278

Figures/Tables 6

References 26

[1]	Takada A, Saito K, Sakai K. Dissecting lesions in a culprit artery of a hemorrhagic focus in the basal ganglia: histopathological analysis by serial sectioning[J]. Neuropathology, 2021, 41(4): 301-305. DOI: 10.1111/neup.12736.
[2]	Mao Y, Shen Z, Zhu H, et al. Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage[J]. Ann Palliat Med, 2020, 9(2): 339-345. DOI: 10.21037/apm.2020.03.12.
[3]	张楼炜,何玉领,潘柏林.探讨急诊微创穿刺引流术对高血压脑出血患者神经功能及预后的影响[J].中国全科医学, 2020, 23(S1): 148-150.
[4]	李艳娜,薛雯雯,赵梦瑜.乌拉地尔与酒石酸美托洛尔治疗高血压合并心力衰竭的临床疗效观察[J].中国临床医生杂志, 2020, 48(6): 659-662. DOI: 10.3969/j.issn.2095-8552.2020.06.010.
[5]	陶珍,陈蕾,程明,等.吡拉西坦联合鼠神经生长因子对急性缺血性脑卒中患者的疗效及Hcy、PCT和皮质醇水平的影响[J].现代生物医学进展, 2020, 20(10): 1944-1948. DOI: 10.13241/j.cnki.pmb.2020.10.032.
[6]	北京市中西医结合学会神经科专业委员会.高血压性脑出血急性期中西医结合诊疗专家共识[J].中国全科医学, 2016, 19(30): 3641-3648. DOI: 10.3969/j.issn.1007-9572.2016.30.001.
[7]	Hinkle JL. Reliability and validity of the national institutes of health stroke scale for neuroscience nurses[J]. Stroke, 2014, 45(3): e32-e34. DOI: 10.1161/STROKEAHA.113.004243.
[8]	Braine ME, Cook N. The Glasgow coma scale and evidence-informed practice: a critical review of where we are and where we need to be[J]. J Clin Nurs, 2016, 26(1-2): 280-293. DOI: 10.1111/jocn.13390.
[9]	Ridha B, Rossor M. The mini mental state examination[J]. Pract Neurol, 2005, 5(5): 298-303. DOI: 10.1111/j.1474-7766.2005.00333.x.
[10]	李利军,胡晋红,王卓,等.药品不良反应严重程度分级评分标准的制定及药品不良反应严重度指数的应用[J].药学服务与研究, 2008, 8(1): 9-13. DOI: 10.3969/j.issn.1671-2838.2008.01.003.
[11]	于生元.脑血管病[M].北京:军事医学科学出版社, 2014: 204-205.
[12]	Reznik ME, Fakhri N, Moody S, et al. Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage[J]. J Neurol Sci, 2020, 416(8): 117000. DOI: 10.1016/j.jns.2020.117000.
[13]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2019)[J].中华神经科杂志, 2019, 52(12): 994-1005. DOI: 10.3760/cma.j.issn.1006-7876.2019.12.003.
[14]	杨晓涛,井建东.微创血肿穿刺清除术在高血压脑出血治疗中的疗效观察及对患者生活质量的影响[J].中国药物与临床, 2020, 20(19): 3262-3264. DOI: 10.11655/zgywylc2020.19.044.
[15]	徐成胜.乌拉地尔对老年AHF伴血压异常患者的疗效及其对心功能、糖脂代谢的影响[J].心血管康复医学杂志, 2020, 29(5): 586-590. DOI: 10.3969/j.issn.1008-0074.2020.05.15.
[16]	藏君,刘爱贤,王亭亭.经颅磁刺激联合吡拉西坦对老年脑梗死患者认知功能及自主神经的影响[J].山东医药, 2021, 61(29): 64-67. DOI: 10.3969/j.issn.1002-266X.2021.29.017.
[17]	王国芳,高扬,谭龙娇.吡拉西坦联合阿替普酶静脉溶栓对急性脑梗死患者神经功能、脑血流动力学及血清Lp-PLA2水平的影响[J].武警后勤学院学报(医学版), 2021, 30(6): 22-29. DOI: 10.16548/j.2095-3720.2021.06.002.
[18]	Koroleva ES, Brazovskaya NG, Levchuk LA, et al. Assessment of neuron-specific enolase and brain-derived neurotrophic factor levels at rehabilitation stages in the early and late recovery periods of ischemic stroke[J]. Neurosci Behav Physiol, 2021, 51(2): 570-576. DOI: 10.1007/s11055-021-01107-0.
[19]	王小雯.血清骨桥蛋白、神经胶质纤维酸性蛋白及生长分化因子15水平在急性脑梗死患者神经损伤及预后评估中的应用价值[J].新乡医学院学报, 2019, 36(5): 479-482. DOI: 10.7683/xxyxyxb.2019.05.019.
[20]	石波,李远辉,黄校权,等.血清S100-β蛋白水平及血糖变异性与重型脑损伤预后的相关性临床研究[J].检验医学与临床, 2019, 16(21): 3118-3120. DOI: 10.3969/j.issn.1672-9455.2019.21.013.
[21]	姚丽娜,时伟,孙喜燕,等.颗粒蛋白前体、基质金属蛋白酶-9及入院时美国国立卫生研究院卒中量表评分对脑梗死病人出血转化的预测价值[J].安徽医药, 2021, 25(5): 966-970. DOI: 10.3969/j.issn.1009-6469.2021.05.030.
[22]	樊宝华,王光宇,张文川.脑出血急性期血小板反应蛋白、基质金属蛋白酶与脑血肿及脑水肿的关系[J].蚌埠医学院学报, 2020, 45(7): 864-867. DOI: 10.13898/j.cnki.issn.1000-2020.07.006.
[23]	Khey KMW, Huard A, Mahmoud SH. Inflammatory pathways following subarachnoid hemorrhage[J]. Cell Mol Neurobiol, 2020, 40 (5): 675-693. DOI: 10.1007/s10571-019-00767-4.
[24]	李欣,李海红,方泽漫,等.白介素-1β对原代培养海马神经元毒性的研究[J].中华行为医学与脑科学杂志, 2009, 18(12): 1061-1063. DOI:10.3760/cma.j.issn.1674-6554.2009.12.003.
[25]	栗春梅,俞晓飞.高迁移率族蛋白B1在脑出血炎症损伤和修复中的作用研究进展[J].中西医结合心脑血管病杂志, 2020, 18(13): 2075-2078. DOI: 10.12102/j.issn.1672-1349.2020.13.013.
[26]	于广亮,高卫丰,万意.颅内血肿微创清除术联合吡拉西坦治疗脑出血的疗效及对血清HMGB-1、IGF-1水平的影响[J].卒中与神经疾病, 2019, 26(2): 178-181. DOI: 10.3969/j.issn.1007-0478.2019.02.011.

项目	观察组（n=43）	对照组（n=43）	χ²/t值	P值
性别（男/女）	25/18	23/20	0.189	0.664
年龄（岁，Mean±SD）	62.54±8.41	61.67±7.58	0.504	0.616
血肿量（mL，Mean±SD）	46.85±5.27	45.72±5.04	1.016	0.313
发病至手术时间（h，Mean±SD）	7.45±1.53	7.13±1.62	0.942	0.349
高血压病程（年，Mean±SD）	9.64±2.05	9.33±2.16	0.683	0.497
入院时GCS评分（分，Mean±SD）	7.86±1.14	7.57±1.03	1.238	0.219
高血脂	16	15	0.048	0.826
糖尿病	17	19	0.191	0.662

项目	观察组（n=43）	对照组（n=43）	χ²/t值	P值
性别（男/女）	25/18	23/20	0.189	0.664
年龄（岁，Mean±SD）	62.54±8.41	61.67±7.58	0.504	0.616
血肿量（mL，Mean±SD）	46.85±5.27	45.72±5.04	1.016	0.313
发病至手术时间（h，Mean±SD）	7.45±1.53	7.13±1.62	0.942	0.349
高血压病程（年，Mean±SD）	9.64±2.05	9.33±2.16	0.683	0.497
入院时GCS评分（分，Mean±SD）	7.86±1.14	7.57±1.03	1.238	0.219
高血脂	16	15	0.048	0.826
糖尿病	17	19	0.191	0.662

组别	例数	治愈	显效	有效	无效	总有效率[例（%）]
观察组	43	10	16	13	4	39（90.70）
对照组	43	5	13	14	11	32（74.42）
Z/χ²值			2.077			3.957
P值			0.038			0.047

组别	例数	治愈	显效	有效	无效	总有效率[例（%）]
观察组	43	10	16	13	4	39（90.70）
对照组	43	5	13	14	11	32（74.42）
Z/χ²值			2.077			3.957
P值			0.038			0.047

组别	例数	NIHSS评分				GCS评分				MMSE评分
组别	例数	治疗前	治疗14 d后	t值	P值	治疗前	治疗14 d后	t值	P值	治疗前	治疗14 d后	t值	P值
观察组	43	24.62±3.78	9.15±2.04	23.617	<0.001	7.86±0.94	13.52±2.36	14.610	<0.001	11.57±2.34	20.21±2.45	16.723	<0.001
对照组	43	24.37±4.02	14.27±2.83	13.472	<0.001	7.67±0.83	10.25±2.07	7.586	<0.001	12.02±2.58	17.34±2.57	9.580	<0.001
t值		0.297	9.624			0.994	6.831			0.847	5.300
P值		0.767	<0.001			0.323	<0.001			0.399	<0.001

Please choose a citation manager

Content to export