不同剂量的钙离子通道拮抗剂对面神经损害的保护作用

背景应用Ca2+通道拮抗剂对周围神经损害保护作用的实验研究较多,但在临床应用中其剂量大小对受损神经保护作用的效果差异尚需探讨.目的应用不同剂量Ca2+通道拮抗剂氟桂利嗪治疗面神经麻痹(简称面瘫),观察治疗1个月后电生理学量化评估结果.设计随机分组,空白对照,随访1个月.单位南京医科大学第一附属医院神经科.对象1999-11/2001-05南京医科大学第一附属医院神经内科门诊面瘫患者35例,男19例,女16例,年龄16～58岁,病程≤3d,未经过任何治疗且瘫痪均为完全性.采用随机抽样方法将初诊患者分为对照组12例、治疗Ⅰ组10例,治疗Ⅱ组13例.方法对照组采用基础治疗,强的松1mg/(kg·d),1次/d,晨服,最大剂量≤60 mg/d,每隔5 d减半量,1个疗程15 d,甲钴胺口服500μg,3次/d.呋喃硫胺口服25mg,3次/d.超短波理疗,1次/d,治疗15 d.共治疗1个疗程.治疗Ⅰ组和治疗Ⅱ组在此基础上进行Ca2+通道拮抗剂治疗治疗Ⅰ组氟桂利嗪5mg,1次/晚,治疗Ⅱ组氟桂利嗪10 mg,1次/晚.治疗前及治疗后1个月分别检测各组患者的Blink反射潜伏期及波幅的变化.主要观察指标各组患者治疗1个月后Blink反射潜伏期和波幅.结果按意向处理分析,35例患者均进入结果分析.①治疗前3组患者Blink反射均呈现面瘫侧传出型阻断,R1,R2均消失.②治疗后1个月Blink反射R1,R2出现,治疗Ⅱ组R1及R2的潜伏期恢复显著优于对照组[(9608±0.575)ms,(31.869±2.934)ms,(11.208±1 490)ms,(37.583±5.408)ms,P＜0.01],而治疗Ⅰ组与对照组比较,R1,R2潜伏期恢复无差异.③治疗后1个月3组Blink反射同侧波幅变化比较无差异.结论较大剂量(10 mg/d)氟桂嗪治疗1个月,可促进面瘫患者面神经功能的恢复,而日剂量5mg时,氟桂嗪对周围神经的保护作用不优于常规治疗,其机制和最适剂量本文未做进一步观察.

Protective effect of calcium channel blocker at different dosages on facial nerve injury

BACKGROUND: There are a lot of researches on the protective action of calcium channel blocker(CCB) on diabetic peripheral neuropathy, but the dosage and the effect on injured nerve need to investigate further in clinical application.OBJECTIVE: To observe the results of electrophysiologic assessment of the effect of CCB flunarizine at different dosages on Bell' s palsy after 1-month treatment.DESIGN: Randomized grouping, blank control and l-month follow up.SETTING: Department of Neurology, First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 35 patients with Bell' s palsy, including 19males and 16 females aged from 16 to 58 and the mean age of 32. 8, were selected from Outpatients of the Department of Neurology, the First Affiliated Hospital to Nanjing Medical University from November 1999 to May 2001. The course of disease was ≤ 3 days. Patients were without any treatment, and all of the facial nerve palsy was complete. According to random samplings, all patients were divided randomly into control group (basic treatment group) with 12 cases and treatment groups with 10 cases in first subgroup and 13 in second subgroup.METHODS: Basic treatment: 1 mg/kg per day prednisone(the maximal dosage ≤ 60 mg/day) was taken once every day and reducing dosage by half every 5 days, with a course of therapy for 15 days. 500 μg methycobal was taken orally three times a day and 25 mg fursulthiamine also orally three times a day. Ultrashort wave physiotherapy was taken once a day for 15 days. On the basis of the basic treatment, patients in the first subgroup accepted 5 mg flunarizine once every night, and 10 mg flunarizine once every night was given to the patients in the second subgroup. The latency and amplitude of Blink response were checked before treatment and after 1-month treatment.MAIN OUTCOME MEASURES: The latency and amplitude of Blink response in every group after 1-month treatment.RESULTS: According to the imagery analysis, 35 patients entered the resulting analysis. Before treatment, the 3 groups of blink responses were all efferential blocking in facioplegic side, and in addition, R1 and R2 all disappeared. After treatment for 1 month, Blink response of R1, R2 appeared. The latency of R1 and R2 in the second treatment group was better than that in control group[ (9. 608 ± 0. 575) ms, (31. 869 ± 2. 934) ms,(11.208±1.490) ms and (37. 583 ±5. 408) ms, P ＜0.01], but there were no differences in this respect between the first treatment group and the control group. The ipsilateral amplitudes of Blind response in the three groups were not different after 1-month treatment.CONCLUSION: After 1-month treatment with flunarizine(10 mg/day),the recovery of facial nerve function can be promoted, but the protective effect of flunarizine(5 mg/day) on peripheral nerve is not superior to that with normal treatment. The mechanism and the proper dosage are not observed further in this study.