阿托伐他汀和瑞舒伐他汀对糖尿病并创伤性蛛网膜下腔出血的疗效及对生活质量的影响比较
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摘要
目的对比阿托伐他汀和瑞舒伐他汀治疗糖尿病并创伤性蛛网膜下腔出血(TSAH)的临床疗效及对患者生活质量的影响。方法选取医院神经外科2012年至2016年收治的糖尿病并TSAH患者72例,随机分为A组和B组,各36例。所有患者均接受基础治疗和用药护理干预,在此基础上,A组患者联合阿托伐他汀治疗,B组患者联合瑞舒伐他汀治疗。结果治疗4周和8周后,两组患者伤侧大脑中动脉(MCA)的收缩期峰值流速(vp)与入院时相比均呈显著下降(P<0.05),且B组明显低于A组(P<0.05);两组患者在脑血管痉挛、再出血和延迟性脑缺血发生率方面无明显差异(P>0.05);治疗1和8周后B组患者脑水肿体积明显小于A组(P<0.05);治疗8周后与入院时相比,B组患者肾小球滤过率明显降低(P<0.05),且生存质量量表(SF-36)评分、FM运动功能、认知功能和日常生活活动能力评分均显著高于A组。结论在相同用药护理干预下,瑞舒伐他汀在改善糖尿病并TSAH患者MCA vp、脑水肿、短期生存质量、运动功能、认知功能和日常生活活动能力方面效果均优于阿托伐他汀,但其对患者肾功能的危害稍强于阿托伐他汀,临床应结合患者实际情况选择用药。
Objective To compare the effects between atorvastatin and rosuvastatin in the treatment of diabetes mellitus patients with traumatic subarachnoid hemorrhage and their effects on quality of life. Methods Totally 72 diabetes mellitus patients with traumatic subarachnoid hemorrhage admitted to the Department of Neurosurgery of our hospital from 2012 to 2016 were selected and randomly divided into group A and group B,36 cases in each group. All the patients were treated with basic treatment and medication nursing intervention,on this basis,group A was given atorvastatin,while group B was given rosuvastatin. Results After 4,8 weeks of treatment,the peak systolic velocity( vp) of middle cerebral artery( MCA) of the two groups showed a significant downward trend compared with admission( P < 0. 05), and that of group B was significantly lower than that of group A( P < 0. 05). There were no significant differences in incidence rates of cerebral vasospasm,rehaemorrhagia and delayed cerebral ischemia between the two groups( P > 0. 05). After1,8 weeks of treatment, the volume of hydrocephalus in group B was significantly smaller than that in group A( P < 0. 05). After8 weeks of treatment,the glomerular filtration rate( GFR) of group B was significantly lower than that of the admission( P < 0. 05),and the SF-36 score, motor function, cognitive function and activity of daily living( ADL) score in group B were significantly higher than those in group A( P < 0. 05). Conclusion Under the same medication nursing intervention,rosuvastatin was better than atorvastatin in improving patients' MCA vp,hydrocephalus,short-term quality of life,motor function,cognitive function and ADL,but it is more harmful to the renal function of the patients than atorvastatin. The clinical use of drugs should be combined with the actual situation of the patients.
Objective To compare the effects between atorvastatin and rosuvastatin in the treatment of diabetes mellitus patients with traumatic subarachnoid hemorrhage and their effects on quality of life. Methods Totally 72 diabetes mellitus patients with traumatic subarachnoid hemorrhage admitted to the Department of Neurosurgery of our hospital from 2012 to 2016 were selected and randomly divided into group A and group B,36 cases in each group. All the patients were treated with basic treatment and medication nursing intervention,on this basis,group A was given atorvastatin,while group B was given rosuvastatin. Results After 4,8 weeks of treatment,the peak systolic velocity( vp) of middle cerebral artery( MCA) of the two groups showed a significant downward trend compared with admission( P < 0. 05), and that of group B was significantly lower than that of group A( P < 0. 05). There were no significant differences in incidence rates of cerebral vasospasm,rehaemorrhagia and delayed cerebral ischemia between the two groups( P > 0. 05). After1,8 weeks of treatment, the volume of hydrocephalus in group B was significantly smaller than that in group A( P < 0. 05). After8 weeks of treatment,the glomerular filtration rate( GFR) of group B was significantly lower than that of the admission( P < 0. 05),and the SF-36 score, motor function, cognitive function and activity of daily living( ADL) score in group B were significantly higher than those in group A( P < 0. 05). Conclusion Under the same medication nursing intervention,rosuvastatin was better than atorvastatin in improving patients' MCA vp,hydrocephalus,short-term quality of life,motor function,cognitive function and ADL,but it is more harmful to the renal function of the patients than atorvastatin. The clinical use of drugs should be combined with the actual situation of the patients.
引文
[1]樊晓军.创伤性蛛网膜下腔出血的临床治疗分析[J].中国实用医药,2012,7(18):126-127.
[2]岑雄图,黄树栋.他汀类药物预防蛛网膜下腔出血患者迟发性脑血管痉挛的疗效[J].中国医药导报,2015,12(9):142-145.
[3]卢璐.他汀类药物对蛛网膜下腔出血干预作用的meta分析[D].郑州:郑州大学,2016.
[4]周庆明,穆苍山,杨凯,等.外伤性蛛网膜下腔出血诊断[J].航空航天医学杂志,2007,18(3):138-139.
[5]Rohn B,Haenggi D,Etminan N,et al.Epilepsy,headache,and quality of life after resection of cerebral arteriovenous malformations[J].J Neurol Surg A Cent Eur Neurosurg,2014,75(4):282-288.
[6]鲍文,陈和木,高晓平.脑卒中患者运动功能评定方法的研究现状及发展趋势[J].安徽医药,2011,15(4):502-505.
[7]Kocaogullar Y,Ilik K,Esen H,et al.Preventive effects of intraperitoneal selenium on cerebral vasospasm in experimental subarachnoid hemorrhage[J].J Neurosurg Anesthesiol,2010,22(1):53-58.
[8]王建飞.创伤性蛛网膜下腔出血临床治疗分析[J].中国实用医药,2012,7(1):129-130.
[9]曹奕波,邰云飞,张振,等.尼莫地平在创伤性蛛网膜下腔出血治疗中的临床疗效[J].中国医药科学,2014,4(22):64-66.
[10]Rabinstein AA.Secondary brain injury after aneurysmal subarachnoid haemorrhage:more than vasospasm[J].Lancet Neurol,2011,10:593-595.
[11]周剑锋.尼莫地平联合阿托伐他汀钙预防蛛网膜下腔出血后脑血管痉挛45例临床评价[J].中国药业,2015,24(19):33-34.
[12]Budohoski KP,Czosnyka M,Kirkpatrick PJ,et al.Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage[J].Nat Rev Neurol,2013,9(3):152-163.
[13]Sahri M,Macdonald RL,Statins:a potential therapeutic addition to treatment for aneurysmal subarachnoid hemorrhage?[J].World Neurosurg,2010,73(6):646-653.
[14]王群芬.综合护理干预对蛛网膜下腔出血患者术后生活质量的影响[J].齐鲁护理杂志,2016,22(20):28-29.
[15]曹智英.施行综合护理干预对蛛网膜下腔出血患者疗效的影响[J].当代医药论丛,2014,12(9):16.
[16]Eugene H,Gyuri K,Ji-Yeon L,et al.Comparison between Atorvastatin and Rosuvastatin in Renal Function Decline among Patients with Diabetes[J].Endocrinol Metab(Seoul),2017,32(2):274-280.
[2]岑雄图,黄树栋.他汀类药物预防蛛网膜下腔出血患者迟发性脑血管痉挛的疗效[J].中国医药导报,2015,12(9):142-145.
[3]卢璐.他汀类药物对蛛网膜下腔出血干预作用的meta分析[D].郑州:郑州大学,2016.
[4]周庆明,穆苍山,杨凯,等.外伤性蛛网膜下腔出血诊断[J].航空航天医学杂志,2007,18(3):138-139.
[5]Rohn B,Haenggi D,Etminan N,et al.Epilepsy,headache,and quality of life after resection of cerebral arteriovenous malformations[J].J Neurol Surg A Cent Eur Neurosurg,2014,75(4):282-288.
[6]鲍文,陈和木,高晓平.脑卒中患者运动功能评定方法的研究现状及发展趋势[J].安徽医药,2011,15(4):502-505.
[7]Kocaogullar Y,Ilik K,Esen H,et al.Preventive effects of intraperitoneal selenium on cerebral vasospasm in experimental subarachnoid hemorrhage[J].J Neurosurg Anesthesiol,2010,22(1):53-58.
[8]王建飞.创伤性蛛网膜下腔出血临床治疗分析[J].中国实用医药,2012,7(1):129-130.
[9]曹奕波,邰云飞,张振,等.尼莫地平在创伤性蛛网膜下腔出血治疗中的临床疗效[J].中国医药科学,2014,4(22):64-66.
[10]Rabinstein AA.Secondary brain injury after aneurysmal subarachnoid haemorrhage:more than vasospasm[J].Lancet Neurol,2011,10:593-595.
[11]周剑锋.尼莫地平联合阿托伐他汀钙预防蛛网膜下腔出血后脑血管痉挛45例临床评价[J].中国药业,2015,24(19):33-34.
[12]Budohoski KP,Czosnyka M,Kirkpatrick PJ,et al.Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage[J].Nat Rev Neurol,2013,9(3):152-163.
[13]Sahri M,Macdonald RL,Statins:a potential therapeutic addition to treatment for aneurysmal subarachnoid hemorrhage?[J].World Neurosurg,2010,73(6):646-653.
[14]王群芬.综合护理干预对蛛网膜下腔出血患者术后生活质量的影响[J].齐鲁护理杂志,2016,22(20):28-29.
[15]曹智英.施行综合护理干预对蛛网膜下腔出血患者疗效的影响[J].当代医药论丛,2014,12(9):16.
[16]Eugene H,Gyuri K,Ji-Yeon L,et al.Comparison between Atorvastatin and Rosuvastatin in Renal Function Decline among Patients with Diabetes[J].Endocrinol Metab(Seoul),2017,32(2):274-280.