纳美芬联合功能性电刺激治疗急性缺血性脑卒中的临床疗效及安全性研究

背景急性缺血性脑卒中患者预后较差,多数患者可能出现认知障碍、失语或偏瘫等后遗症,严重影响患者的生存质量。纳美芬作为治疗急性缺血性脑卒中的新型阿片类受体拮抗剂,与功能性电刺激联合治疗后的有效性和安全性如何还未有报道。目的探究纳美芬联合功能性电刺激治疗急性缺血性脑卒中的临床疗效及安全性。方法选取2018年6月至2020年6月陕西省人民医院收治的急性缺血性脑卒中患者102例为研究对象。采用Mininize分层随机软件将患者分为联合治疗组(n=51)和对照组(n=51)。联合治疗组患者在常规治疗的基础上采用盐酸纳美芬联合功能性电刺激治疗,对照组患者在常规治疗的基础上采用与纳美芬剂量相同的0.9%氯化钠注射液及功能性电刺激治疗,两组患者均治疗2周。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、Barthel指数、Fugl-Meyer运动功能评定量表评分、大脑中动脉(MCA)的血流动力学指标〔包括平均血流速度、搏动指数(PI)、阻力指数(RI)〕和血清强啡肽A(1-13)、β-内啡肽(β-EP)、D-二聚体及治疗期间不良反应发生率。结果联合治疗组患者治疗后NIHSS评分低于对照组,GCS评分高于对照组(P<0.05);对照组、联合治疗组患者治疗后NIHSS评分分别低于本组治疗前,GCS评分分别高于本组治疗前(P<0.05)。联合治疗组患者治疗后Barthel指数、Fugl-Meyer运动功能评定量表评分高于对照组(P<0.05);对照组、联合治疗组患者治疗后Barthel指数、Fugl-Meyer运动功能评定量表评分分别高于本组治疗前(P<0.05)。联合治疗组患者治疗后MCA平均血流速度快于对照组,MCA PI、RI低于对照组(P<0.05);对照组、联合治疗组患者治疗后MCA平均血流速度分别快于本组治疗前,MCA PI、RI分别低于本组治疗前(P<0.05)。联合治疗组患者治疗后血清强啡肽A(1-13)、β-EP、D-二聚体低于对照组(P<0.05);对照组、联合治疗组患者治疗后血清强啡肽A(1-13)、β-EP、D-二聚体分别低于本组治疗前(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论纳美芬联合功能性电刺激能有效改善急性缺血性脑卒中患者的神经功能、日常生活活动能力、肢体运动功能、血流动力学指标,降低血清强啡肽A(1-13)、β-EP、D-二聚体,且安全性良好。

Clinical Efficacy and Safety of Nalmefene Combined with Functional Electrical Stimulation in the Treatment of Acute Ischemic Stroke

Background The prognosis of patients with acute ischemic stroke is poor,and most patients may develop sequelae such as cognitive dysfunction,aphasia or hemiplegia,which seriously affect the quality of life of patients.As a new opioid receptor antagonist for the treatment of acute ischemic stroke,the efficacy and safety of nalmefene combined with functional electrical stimulation have not been reported.Objective To explore the clinical efficacy and safety of nalmefene combined with functional electrical stimulation in the treatment of acute ischemic stroke.Methods A total of 102 patients with acute ischemic stroke treated in Shaanxi Provincial People's Hospital from June 2018 to June 2020 were selected as the research objects.The patients were divided into combined treatment group(n=51)and control group(n=51)by Mininize stratified random software.Patients in the combined treatment group were treated with nalmefene hydrochloride combined with functional electrical stimulation on the basis of conventional treatment.Patients in the control group received 0.9%sodium chloride solution with the same dose as nalmefene and functional electrical stimulation on the basis of conventional treatment,and both groups were treated for 2 weeks.National Institutes of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,Barthel index,Fugl-Meyer Motor Assessment Scale score,hemodynamic indexes[including mean blood flow velocity,pulsatile index(PI),resistance index(RI)]of middle cerebral artery(NCA),serum enkephin A(1-13),β-endorphin(β-EP)and D-dimer before and after treatment and the incidence of adverse reactions during treatment were compared between the two groups.Results After treatment,the NIHSS score of the combined treatment group was lower than that of the control group,and the GCS score was higher than that of the control group(P<0.05).The NIHSS scores of the control group and the combined treatment group after treatment were lower than those before treatment,and the GCS scores were higher than those before treatment,respectively(P<0.05).After treatment,Barthel index and Fugl-Meyer Motor Assessment Scale score in the combined treatment group were higher than those in the control group(P<0.05).Barthel index and Fugl-Meyer Motor Assessment Scale score after treatment in the control group and combined treatment group were higher than those before treatment,respectively(P<0.05).After treatment,the average blood flow velocity of MCA in the combined treatment group was faster than that in the control group,and PI and RI of MCA were lower than those in the control group(P<0.05).The average blood flow velocity of MCA of the control group and the combined treatment group after treatment was faster than that before treatment,and the PI and RI of MCA were lower than those before treatment,respectively(P<0.05).After treatment,serum dynorphin A(1-13),β-EP and D-dimer in the combined treatment group were lower than those in the control group(P<0.05).Serum dynorphin A(1-13),β-EP and D-dimer of the control group and the combined treatment group after treatment were lower than those before treatment,respectively(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Nalmefene combined with functional electrical stimulation can effectively improve the nervous function,activities of daily living,limb motor function and hemodynamic indexes of patients with acute ischemic stroke,reduce serum enkephalin A(1-13),β-EP and D-dimer,and with good safety.