纳美芬治疗大脑中动脉主干脑梗死的临床研究

目的 探讨纳美芬治疗急性脑梗死的疗效及其可能的作用机制.方法 将100例大脑中动脉主干脑梗死患者完全随机分为纳美芬组（50例）和对照组（50例）.对照组仅给予常规治疗,而纳美芬组在常规治疗的基础上予以静脉注射盐酸纳美芬0.4 mg/d,连续10 d.所有患者用药前及用药后进行格拉斯哥昏迷量表（GCS）及美国国立卫生院卒中量表（NIHSS）评分,部分患者给予基质金属蛋白酶9（MMP-9）及磁共振灌注成像（PWI）检查判定治疗效果及明确梗死病灶变化,并进行统计学处理.结果 ①纳美芬组GCS评分用药前为（7.2±2.3）分,用药后10 d为（9.5±2.9）分,对照组GCS评分用药前为（7.1±1.9）分,用药后10 d为（8.1±2.7）分,2组比较差异有统计学意义（P＜0.05）;②纳美芬组NIHSS用药前为（22 ±4）分,用药后10d为（17±5）分,对照组NIHSS用药前为（23 ±4）分,用药后10 d为（20 ±5）分,2组比较差异有统计学意义（P＜0.05）;③在治疗后10d,纳美芬组MMP-9浓度明显低于对照组,2组比较差异有统计学意义（P＜0.05）.④在治疗第10天,纳美芬组PWI检查中,脑血流较对照组增加幅度大,对比剂平均通过时间较对照组明显减低,2组比较差异有统计学意义（P＜0.05）.结论 阿片受体拮抗剂纳美芬可明显改善大脑中动脉主干脑梗死患者的意识障碍、神经功能障碍和脑血流量,减低炎性因子MMP-9水平可能是纳美芬有效治疗急性脑梗死的机制之一.

Clinical observation of nalmefene in massive cerebral infarction

Objective To assess their clinical effects and prognosis influence of nalmefene treated for middle cerebral artery infarction.Methods Totally 100 middle cerebral artery infarction patients were enrolled in this study and divided to nalmefene group and control group.Patients in both groups were treated by basic treatment.Nalmefene group was treated by nalmefene.Before and 10 days after treatment,Glasgow coma scale（GCS）,National Institutes of Health Stroke Scale（NIHSS）,matrix metallopro teinase 9（MMP-9） and perfusion weighted imaging（PWI） were analyzed.Results ①The GCS score of nalmefene group was 7.2 ± 2.3 before medication and 9.5 ± 2.9 after medication.The control group was 7.1 ± 1.9 before medication and 8.1-± 2.7 after medication （P 〈 0.05）.②The NIHSS score of treatment group was 22 ± 4 before medication and 17 ± 5 after medication.The control group was 23 ± 4 before medication and 20 ± 5 after medication （P 〈 0.05）.③After treatment of 10 days,MMP-9 concentration in nalmefene group was significantly lower than that in the control group（P 〈 0.05）.④ In the treatment of 10 days,in PWI of nalmefene group,these patients＇ cerebral blood flow（CBF） large range increased than the control group,these patients＇ mean transit time（MTT） obviously reduced than the control group.The difference was statistically significant （P 〈 0.05）.Conclusions Nalmefene can significantly improve the prognosis of the brain artery infarction patients with disturbance of consciousness and nerve dysfunction.Nalmefene can improve blood flow in the brain artery infarction patients.Nalmefene can reduce inflammatory factor levels of MMP-9; nalmefene may be an option of the treatment of acute cerebral infarction.Nalmefene may improve the prognosis of patient.