牟素花 杨清成 张向东

【摘要】 目的 探討醒脑静注射液联合纳洛酮治疗急性脑卒中伴意识障碍患者的临床疗效。

方法 回顾性分析2018年1月～2020年5月157例急性脑卒中伴意识障碍患者的临床资料，按治疗方案不同分组，在常规治疗基础上予以纳洛酮的74例为对照组，在常规治疗基础上予以醒脑静注射液联合纳洛酮的83例为研究组。比较两组临床疗效、治疗前后意识状态（GCS评分）、神经功能（NIHSS评分）、大脑动脉血流速度、血清神经元特异性烯醇化酶（NSE）、超敏C反应蛋白（hs-CRP）、一氧化氮（NO）、血浆内皮素-1（ET-1）水平、不良反应发生率。

结果 研究组总有效率为92.77%（77/83），高于对照组的75.68%（56/74），差异有统计学意义（P<0.01）;治疗后研究组GCS评分高于对照组，NIHSS评分低于对照组，差异有统计学意义（P<0.001）;治疗后，研究组大脑中动脉（MCA）、后动脉（PCA）、前动脉（ACA）血流速度均高于对照组（P<0.001），血清NSE、hs-CRP、血浆ET-1水平低于对照组，NO水平高于对照组（P<0.001）。

结论 醒脑静注射液联合纳洛酮治疗急性脑卒中伴意识障碍患者临床疗效显著，可有效促进脑血流灌注恢复，发挥脑保护作用，减轻脑细胞损伤，进而提升患者意识状态及神经功能。

【关键词】 急性脑卒中;意识障碍;醒脑静注射液;纳洛酮;神经功能;脑血流灌注

中图分类号：R743.3   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.03.011

Efficacy evaluation of Xingnaojing injection combined with naloxone in the treatment of acute cerebral apoplexy with consciousness disorder

MOU Suhua， YANG Qingcheng， ZHANG Xiangdong

（Department of Neurology， Anyang People's Hospital， Anyang 455000， Henan， China）

【Abstract】 Objective To investigate the clinical efficacy of Xingnaojing injection combined with naloxone in the treatment of acute stroke patients with consciousness disorder.

Methods Clinical data of 157 patients with acute stroke and consciousness disorder in hospital from January 2018 to May 2020 were retrospectively analyzed. According to different treatment regiments， 74 patients treated with naloxone on the basis of routine treatment were selected as control group， and 83 patients treated with Xingnaojing injection combined with naloxone on the basis of routine treatment as study group. And then， clinical efficacy， state of consciousness （GCS score）， neurological function （NIHSS score）， cerebral artery flow velocity， serum neuron-specific enolase （NSE）， hypersensitive C-reactive protein （hs-CRP）， nitric oxide （NO）， plasma endoderin-1 （ET-1） levels before and after treatment as well as the incidence of adverse reactions were compared between the two groups.

Results The total effective rate of the study group was 92.77% （77/83）， higher than that of the control group 75.68%（56/74）， and difference was statistically significant （P < 0.01）. After treatment， GCS score of the study group was higher than that of the control group， and NIHSS score was lower than that of the control group， and difference was statistically significant （P < 0.001）; the flow velocities of middle cerebral artery （MCA）， posterior cerebral artery （PCA） and anterior cerebral artery （ACA） in the treatment group were higher than those in the control group （P < 0.001）; serum NSE， hs-CRP and plasma ET-1 levels in the study group were lower than those in the control group， and NO level was higher than that in the control group （P < 0.001）.

Conclusion Xingnaojing injection combined with naloxone has a significant clinical effect in the treatment of acute stroke patients with consciousness disorder， which can effectively promote the recovery of cerebral blood perfusion， play a role of brain protection， alleviate brain cell damage， and then improve patients' consciousness and neurological function.

【Key words】 acute stroke; consciousness disorder; Xingnaojing injection; naloxone; neurological function; cerebral blood perfusion

脑卒中属临床常见神经系统疾病，受脑细胞水肿，脑组织缺血、缺氧，二氧化碳潴留等诸多因素影响，易使神经系统功能出现紊乱，进而患者出现意识障碍，需及时予以有效治疗，恢复局部血流灌注状态，促进患者意识及神经功能提升[1～2]。纳洛酮属临床治疗神经系统疾病常用促醒剂，可一定程度提升脑局部血流量，改善患者神经功能，但部分患者经治疗后恢复效果不理想[3]。既往临床研究发现，及时对缺血性半暗带区实施脑保护可有效提高受损神经元活性，同时改善局部脑组织缺血耐受性，对减轻脑损伤具有积极作用[4]。……