摘要：
目的 观察纳洛酮注射液联合布美他尼注射液治疗急性脑梗死后脑水肿的临床疗效及安全性.方法 将82例急性脑梗死伴脑水肿患者随机分为对照组41例和试验组41例.对照组予以20％甘露醇注射液每次100 mL,qd,静脉滴注,持续使用7～10d;试验组在对照组治疗的基础上,予以纳洛酮每次4 mg,qd,静脉滴注,持续使用14d+布美他尼每次2 mg,qd,静脉注射,持续使用7～10d.比较2组患者的临床疗效、S-100β、神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、脑水肿体积,以及药物不良反应的发生情况.结果 治疗后,试验组和对照组的总有效率分别为95.12％(39例/41例)和75.61％(31例/41例),差异有统计学意义(P＜0.05).治疗后,试验组和对照组的S-100β分别为(0.42±0.05)和(0.54±0.07) μg·L-1,NSE分别为(9.48±1.29)和(12.73±1.62)μg·L-1,MBP分别为(1.43±0.17)和(1.72±0.28)μg·L-1,脑水肿体积分别为(20.31±2.52)和(24.53±3.15)mL,差异均有统计学意义(均P＜0.05).2组患者的药物不良反应均以有电解质紊乱和尿检异常为主.试验组和对照组的总药物不良反应发生率分别为12.20％和17.07％,差异无统计学意义(P＞0.05).结论 纳洛酮注射液联合布美他尼注射液治疗急性脑梗死后脑水肿的临床疗效确切,其能显著降低患者的S-100β、NSE和MBP水平,且不增加药物不良反应的发生率.%Objective To observe the clinical efficacy and safety of naloxone injection combined with bumetanide injection in the treatment of cerebral edema after acute cerebral infarction.Methods Eighty-two patients with cerebral edema after acute cerebral infarction were randomly divided into control and treatment groups with 41 cases per group.Control group was treated with 20％ mannitol injection100 mL per time,qd,intravenous drip,continuous use for 7-10 days.Treatment group was treated with naloxone 4 mg per time,qd,intravenous drip,continuous use for 14 d + bumetanil 2 mg per time,qd,intravenous injection,continuous use for 7-10 days,on the basis of control group.The clinical efficacy,S-100β,neuronal specific enolase (NSE),myelin basic protein (MBP),cerebral edema volume and adverse drug reactions were compared between two groups.Results After treatment,the total effective rates of treatment and control groups were 95.12％ (39 cases/41 cases) and 75.61％ (31 cases/41 cases) with significant difference (P ＜ 0.05).After treatment,the main indexes in treatment and control groups were compared:S-100β were(0.42 ± 0.05) and (0.54 ± 0.07) μg · L-1,NSE were (9.48 ± 1.29) and (12.73 ± 1.62)μg · L-1,MBP were (1.43 ± 0.17) and (1.72 ± 0.28)μg · L-1,cerebral edema volume were (20.31 ± 2.52) and (24.53 ± 3.15) mL,the differences were statistically significant (all P ＜ 0.05).The adverse drug reactions of two groups were electrolyte disorders and urinalysis.The total incidences of adverse drug reactions in treatment and control groups were 12.20％ and 17.07％ without significant difference (P ＞ 0.05).Conclusion Naloxone injection combined with bumetanide injection has a definitive clinical efficacy in the treatment of cerebral edema after acute cerebral infarction,which can significantly reduce the Levels of S-100β,NSE and MBP,without increasing the incidence of adverse drug reactions.
