摘要
目的观察应用甘油果糖联合吡拉西坦治疗2型糖尿病患者脑出血后脑水肿的安全性和有效性。方法 138名2型糖尿病合并脑出血的患者随机分为三组:甘露醇组、甘油果糖组和甘油果糖-吡拉西坦联合组(合剂组),每组46例。比较各组患者高颅压症状的缓解情况和降压效果。通过头颅CT检查和斯堪的那维亚卒中量表(SSS)评分,比较三组患者脑出血和颅内水肿吸收情况及神经功能缺损改善情况。观察患者血清肌酐和血钾浓度变化情况评价用药的安全性。结果三组患者颅内高压症状缓解率分别为97.83%、93.48%和97.83%,差异无统计学意义。首次用药后颅内压最大降幅、起效时间、高峰时间和持续时间等指标,合剂组与甘露醇组差异也均无统计学意义,但合剂组颅内压最大降幅和起效时间同甘油果糖组差异具有统计学意义(12.8±4.9 mm Hg vs.10.5±4.5 mm Hg,P=0.03;0.42±0.19 h vs.0.62±0.22 h,P<0.01)。合剂组脑出血和颅内水肿吸收量,SSS评分下降值分别为16.6±5.9 m L、14.3±6.2 m L和19.12±7.27分,均优于甘露醇组(13.9±5.6 m L,P=0.04;11.3±5.2 m L,P=0.02;15.12±6.87分,P<0.01)和甘油果糖组(13.4±4.7 m L,P<0.01;10.5±5.7 m L,P<0.01;14.18±5.76分,P<0.01)。三组发生肾功异常和电解质异常的患者例数分别为13例与11例、3例与3例、3例与4例,甘油果糖组和合剂组发生率显著低于甘露醇组,差异具有统计学意义。结论应用甘油果糖联合吡拉西坦治疗2型糖尿病患者脑出血后脑水肿效果优于单用甘露醇或甘油果糖,值得临床推广。
Objective To observe the safety and efficacy of glycerol fructose combined with piracetam in the treatment of encephaledema after intracerebral hemorrhage in patients with type II diabetes. Methods One hundred and thirty-eight type II diabetes patients with intracerebral hemorrhage were randomly divided into mannitol group,glycerol fructose group,and combination group（ glycerol fructose combined with piracetam）,with 46 cases in each group. Remission of high intracranial pressure symptoms and antihypertensive effects were compared between these groups. Head CT examination and Scandinavian Stroke Scale（ SSS） score were used to compare intracerebral hemorrhage,absorption of intracranial edema,and improvement in neurological impairment. Changes in serum creatinine and serum potassium concentration were examined to evaluate safety. Results The remission rate of hypertensive symptoms in the three groups were 97. 83%,93. 48%,and 97. 83%,respectively,with no significant differences. As for the indices including maximum decrease in intracranial pressure after first administration,onset time,peak time,and duration,the differences between the combination group and the mannitol group had no statistical significance,but significant differences existed in maximum decrease in intracranial pressure and onset time between the combination group and the glycerol fructose group（ 12. 8 ± 4. 9 mm Hg vs 10. 5 ±4. 5 mm Hg,P = 0. 03; 0. 42 ± 0. 19 h vs 0. 62 ± 0. 22 h,P〈0. 01）. Absorption of intracerebral hemorrhage and edema and decrease in SSS score in the combination group were 16. 6 ± 5. 9 ml,14. 3 ± 6. 2 ml,and 19. 12 ± 7. 27,respectively,all superior to those in the mannitol group（ 13. 9 ± 5. 6 ml,P = 0. 04; 11. 3 ± 5. 2 ml,P = 0. 02; 15. 12 ± 6. 87,P〈0. 01） and the glycerin fructose group（ 13. 4 ± 4. 7 ml,P〈0. 01; 10. 5 ± 5. 7 ml,P〈0. 01; 14. 18 ± 5. 76,P〈0. 01）. The numbers of cases of abnormal renal function and abnormal electrolytes in the three groups were 13 and 11,3 and 3,and 3 and 4,respectively,and the incidence in the glycerol fructose group and the combination group was significantly lower than that in the mannitol group. Conclusions For patients with type II diabetes,the clinical effect of glycerol fructose combined with piracetam in treatment of encephaledema after intracerebral hemorrhage is better than the single application of mannitol or glycerol fructose,and is worthy of clinical promotion.
出处
《国际神经病学神经外科学杂志》
北大核心
2015年第4期324-328,共5页
Journal of International Neurology and Neurosurgery
关键词
2型糖尿病
脑出血
脑水肿
甘油果糖
吡拉西坦
type Ⅱ diabetes type Ⅱ
intracerebral hemorrhage
encephaledema
glycerol fructose
piracetam
