小剂量甘露醇联合布美他尼治疗老年急性大面积脑梗死并发脑水肿的效果和安全性分析(1)
[摘要]目的 评价小剂量甘露醇联合布美他尼治疗老年急性大面积脑梗死并发脑水肿的效果和安全性。方法 选取2010年1月～2015年12月我院收治的106例老年急性大面积脑梗死并发脑水肿患者，采用随机数字表法分为研究组(54例)和对照组(52例)。研究组给予小剂量甘露醇，每日2次给药并联合布美他尼，对照组给予小剂量甘露醇，每日3次给药，两组同时给予抗血小板聚集、脑保护、调脂、稳定动脉粥样硬化斑块等神经内科常规治疗，观察两组的临床疗效及不良反应。结果 研究组和对照组的总有效率分别为87.0%和88.4%，两组比较差异无统计学意义(P>0.05)。研究组的不良反应总发生率为18.5%，显著低于对照组的30.8%，差异有统计学意义(P<0.05)。结论 小剂量甘露醇联合布美他尼是治疗老年急性大面积脑梗死并发脑水肿较为合理的方法，并且安全性好。
[关键词]脑水肿；老年；联合用药；疗效；不良反应
[中图分类号] R742.7 [文献标识码] A [文章编号] 1674-4721(2017)02(a)-0083-03
[Abstract]Objective To evaluate the efficacy and safety of small amount of Mannitol combined with Bumetanide in the treatment of elderly patients with acute massive cerebral infarction with cerebral edema.Methods 106 elderly patients with acute massive cerebral infarction with cerebral edema in our hospital fron January 2010 to December 2015 were selected and divided into the study group (54 cases) and the control group (52 cases) by random number table method.The study group was treated with low dose Mannitol 2 times daily dosing and combined Bumetanide，the control group was treated with low-dose Mannitol daily for 3 times.Antiplatelet aggregation，brain protection，lipid-lowering，stable atherosclerotic plaques and other neurological routine treatment were given in the two groups.The clinical efficacy and adverse reactions of the two groups were observed.Results The total effective rate of the study group and the control group were 87.0% and 88.4%，respectively.There was no significant difference between the two groups (P>0.05).The total incidence rate of adverse reactions in the study group was 18.5%，which was lower than that of the control group (30.8%)，with significant difference (P<0.05).Conclusion Small amount of Mannitol combined with Bumetanide treatment in elderly patients with acute massive cerebral infarction with cerebral edema is more reasonable，and good safety.
[Key words]Brain edema；Old age；Combined medication；Efficacy；Adverse reaction
急性大面積脑梗死病情恶化或死亡的主要原因是脑梗死后脑水肿导致的脑疝[1]。随着对脑梗死后脑水肿发生机制的深入研究，已经确定其早期为细胞毒性水肿，后期为血管源性水肿[2]，这为其合理治疗提供了依据。甘露醇是临床上降颅压、防治脑水肿的经典药物，但大剂量给药经常诱发或加重心、肾功能不全及水电解质紊乱，尤其是老年患者。近年来我院采用小剂量甘露醇联合布美他尼治疗老年急性大面积脑梗死并发脑水肿，取得了满意效果，现报道如下。
1资料与方法
1.1一般资料
前瞻性连续选择2010年1月～2015年12月于我院神经内科住院的符合急性大面积脑梗死诊断标准[1]的106例老年患者作为研究对象，发病6～12 h内入院，均经头颅CT或MRI检查证实为颈内动脉主干或大脑中动脉主干供血区大面积脑梗死伴有脑水肿及占位效应。其中左侧颈内动脉闭塞15例，右侧颈内动脉闭塞11例，左侧大脑中动脉闭塞52例，右侧大脑中动脉闭塞28例。排除合并明显心功能不全、水电解质紊乱、严重低血压及肝肾功能不全患者。将入选患者按照随机数字表法分为研究组(54例)和对照组(52例)。研究组中，男性30例，女性24例；年龄为65～80岁，平均(68.5±5.6)岁。对照组中，男性27例，女性25例；年龄66～79岁，平均(67.9±5.8)岁。所有患者均有不同程度的偏瘫、失语症状，部分患者有嗜睡、甚至昏迷表现，治疗前心、肾功能及血清离子检验正常。两组的年龄、性别、发病时间、神经功能缺损程度积分(NIHSS评分)、合并症等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。本研究经我院医学伦理委员会批准，全部患者均签署知情同意书。 (张艳影 石振东)
[关键词]脑水肿；老年；联合用药；疗效；不良反应
[中图分类号] R742.7 [文献标识码] A [文章编号] 1674-4721(2017)02(a)-0083-03
[Abstract]Objective To evaluate the efficacy and safety of small amount of Mannitol combined with Bumetanide in the treatment of elderly patients with acute massive cerebral infarction with cerebral edema.Methods 106 elderly patients with acute massive cerebral infarction with cerebral edema in our hospital fron January 2010 to December 2015 were selected and divided into the study group (54 cases) and the control group (52 cases) by random number table method.The study group was treated with low dose Mannitol 2 times daily dosing and combined Bumetanide，the control group was treated with low-dose Mannitol daily for 3 times.Antiplatelet aggregation，brain protection，lipid-lowering，stable atherosclerotic plaques and other neurological routine treatment were given in the two groups.The clinical efficacy and adverse reactions of the two groups were observed.Results The total effective rate of the study group and the control group were 87.0% and 88.4%，respectively.There was no significant difference between the two groups (P>0.05).The total incidence rate of adverse reactions in the study group was 18.5%，which was lower than that of the control group (30.8%)，with significant difference (P<0.05).Conclusion Small amount of Mannitol combined with Bumetanide treatment in elderly patients with acute massive cerebral infarction with cerebral edema is more reasonable，and good safety.
[Key words]Brain edema；Old age；Combined medication；Efficacy；Adverse reaction
急性大面積脑梗死病情恶化或死亡的主要原因是脑梗死后脑水肿导致的脑疝[1]。随着对脑梗死后脑水肿发生机制的深入研究，已经确定其早期为细胞毒性水肿，后期为血管源性水肿[2]，这为其合理治疗提供了依据。甘露醇是临床上降颅压、防治脑水肿的经典药物，但大剂量给药经常诱发或加重心、肾功能不全及水电解质紊乱，尤其是老年患者。近年来我院采用小剂量甘露醇联合布美他尼治疗老年急性大面积脑梗死并发脑水肿，取得了满意效果，现报道如下。
1资料与方法
1.1一般资料
前瞻性连续选择2010年1月～2015年12月于我院神经内科住院的符合急性大面积脑梗死诊断标准[1]的106例老年患者作为研究对象，发病6～12 h内入院，均经头颅CT或MRI检查证实为颈内动脉主干或大脑中动脉主干供血区大面积脑梗死伴有脑水肿及占位效应。其中左侧颈内动脉闭塞15例，右侧颈内动脉闭塞11例，左侧大脑中动脉闭塞52例，右侧大脑中动脉闭塞28例。排除合并明显心功能不全、水电解质紊乱、严重低血压及肝肾功能不全患者。将入选患者按照随机数字表法分为研究组(54例)和对照组(52例)。研究组中，男性30例，女性24例；年龄为65～80岁，平均(68.5±5.6)岁。对照组中，男性27例，女性25例；年龄66～79岁，平均(67.9±5.8)岁。所有患者均有不同程度的偏瘫、失语症状，部分患者有嗜睡、甚至昏迷表现，治疗前心、肾功能及血清离子检验正常。两组的年龄、性别、发病时间、神经功能缺损程度积分(NIHSS评分)、合并症等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。本研究经我院医学伦理委员会批准，全部患者均签署知情同意书。 (张艳影 石振东)