低频重复经颅磁刺激联合依达拉奉对脑梗死失语患者炎性因子及脑代谢产物的影响

摘要

目的:探讨依达拉奉联合低频重复经颅磁刺激(low-rTMS)对脑梗死失语患者炎性因子及脑代谢产物的影响.方法:选取2015年3月~2016年3月收治的ACI运动性失语患者60例为研究对象,随机分为观察组和对照组.2组均给予降颅压、降血压、抗血小板聚集、调节血脂、对症支持等,依达拉奉30 mg+生理盐水100 mL静脉滴注,2次/d,连续用药2周,观察组在上述基础上联合rTMS进行治疗,连续治疗10 d.2组均于治疗前及治疗后1周、2周测定超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α),于治疗前及治疗后1周、2周采用磁共振波谱(MRS)测定Broca区的N-乙酰天门冬氨(NAA)、胆碱(Cho);于治疗前及治疗后2周、3个月、6个月采用汉语失语检查表(ABC)评定语言功能.结果:观察组治疗后1周、2周hs-CRP、IL-6、IL-8、TNF-α水平低于同期对照组,观察组治疗后1周、2周左侧NAA值高于同期对照组,Cho值低于同期对照组,观察组治疗后2周、3个月、6个月ABC评分高于同期对照组.结论:依达拉奉联合low-rTMS可有效抑制ACI患者机体炎性反应,改善神经功能缺损程度,有效促进皮层语言神经网络的恢复.%Objective: To explore the effect of low-rTMS in combined with edaravone on the inflammatory cytokines and cerebral metabolites in patients with cerebral infarction and aphasia.Methods: A total of 60 patients with acute cerebral infarction (ACI) and motor aphasia who were admitted in our hospital from March, 2015 to March, 2016 were included in the study and randomized into the observation group and the control group.The patients in the control group were given blood pressure reduction, intracranial pressure reduction, blood lipid regulation, anti-platelet aggregation, symptomatic and supportive treatments, edaravone (30 mg) + normal saline (100 mL), ivdrip, 2 times/d, continuously for 2 weeks.On this basis, the patients in the observation group were given additional rTMS, continuously for 10 d.Hs-CRP, IL-6, IL-8, and TNF-α level before treatment, 1 week and 2 weeks after treatment in the two groups were detected.MRS was used to detect NAA and Cho in Broca district before treatment, 1 week and 2 weeks after treatment in the two groups.ABC was used to evaluate the linguistic function before treatment, 2 weeks, 3 months, and 6 months in the two groups.Results: Hs-CRP, IL-6, IL-8, and TNF-α levels 1 week and 2 weeks after treatment in the observation group were significantly lower than those in the control group (P<0.05).NAA value on the left side 1 week and 2 weeks after treatment in the observation group was significantly higher than that in the control group (P<0.05), while Cho value was significantly lower than that in the control group (P<0.05).ABC score 2 weeks, 3 months, and 6 months after treatment in the observation group was significantly higher than that in the control group (P<0.05).Conclusions: Edaravone in combined with low-rTMS in the treatment of ACI can effectively inhibit the inflammatory reaction, improve the neurological deficit degree, and promote the recovery of cortex language neural network.