CAJ | 학술논문

目的：探讨新型自由基清除剂依达拉奉治疗急性脑血管病（ACVD）并发多器官功能障碍综合征（MODS）的效果。方法将2008年9月至2012年9月江苏大学附属医院及镇江市第四人民医院收治的104例 ACVD 并发MODS 患者（伴肺功能衰竭、胃肠功能衰竭、心功能衰竭、肾前性肾功能衰竭）分为依达拉奉组（55例）和常规治疗组（49例），排除重度肾功能衰竭和肝动脉衰竭患者。两组均实施常规治疗，依达拉奉组患者在此基础上加依达拉奉30 mg每天静脉滴注2次。比较两组患者治疗前后急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、格拉斯哥昏迷评分（GCS）、美国国立卫生研究院神经功能缺损评分（NIHSS），以及日常生活能力量表（ADL）评分，同时统计死亡患者数。结果两组患者治疗后APACHEⅡ、GCS、NIHSS、ADL评分均较治疗前改善明显，差异均有统计学意义（P＜0.05或0.01）；且依达拉奉组患者治疗后上述各评分均优于常规治疗组，差异均有统计学意义（P＜0.05）。依达拉奉组患者病死率[34.55%（19/55）]明显低于常规治疗组[55.10%（27/49）]，差异有统计学意义（χ2=4.439，P=0.035）。结论 ACVD患者并发MODS后，通过炎症介质、缺血再灌注损伤等机制使机体处于氧化应激状态，及早给予依达拉奉治疗，可以消除自由基“瀑布效应”，发挥其神经保护作用，降低死亡率。
목적：탐토신형자유기청제제의체랍봉치료급성뇌혈관병（ACVD）병발다기관공능장애종합정（MODS）적효과。방법장2008년9월지2012년9월강소대학부속의원급진강시제사인민의원수치적104례 ACVD 병발MODS 환자（반폐공능쇠갈、위장공능쇠갈、심공능쇠갈、신전성신공능쇠갈）분위의체랍봉조（55례）화상규치료조（49례），배제중도신공능쇠갈화간동맥쇠갈환자。량조균실시상규치료，의체랍봉조환자재차기출상가의체랍봉30 mg매천정맥적주2차。비교량조환자치료전후급성생이학여만성건강상황평분Ⅱ（APACHEⅡ）、격랍사가혼미평분（GCS）、미국국립위생연구원신경공능결손평분（NIHSS），이급일상생활능역량표（ADL）평분，동시통계사망환자수。결과량조환자치료후APACHEⅡ、GCS、NIHSS、ADL평분균교치료전개선명현，차이균유통계학의의（P＜0.05혹0.01）；차의체랍봉조환자치료후상술각평분균우우상규치료조，차이균유통계학의의（P＜0.05）。의체랍봉조환자병사솔[34.55%（19/55）]명현저우상규치료조[55.10%（27/49）]，차이유통계학의의（χ2=4.439，P=0.035）。결론 ACVD환자병발MODS후，통과염증개질、결혈재관주손상등궤제사궤체처우양화응격상태，급조급여의체랍봉치료，가이소제자유기“폭포효응”，발휘기신경보호작용，강저사망솔。
Objective To investigate the effect of edaravone as a new type free radical scavenger in treating acute cere brovascular disorder (ACVD) complicating multiple organ disfunction syndrome (MODS). Methods 104 patients with ACVD complicating MODS(complicating lung function failure,gastrointestinal function failure,cardiac function failure and pre-renal renal function failure) in our two hospitals from September 2008 to September 2012 were divided into the edaravone group (55 cases) and the conventional treatment group(49 cases). The two groups were implemented the conventional therapy. On this basis the edaravone group was added with edaravone 30 mg by intravenous drip,twice daily,except for the cases of severe renal function failure and liver function failure. The scores of the acute physiological and chronic health evaluation Ⅱ (APACHEⅡ),Glasgow coma score(GCS),national institutes of health stroke scale(NIHSS) score and activity of daily living scale(ADL) score before and after treatment were compared between the two groups. At the same time the dead cases were performed the statistics. Results The scores of APACHEⅡ,GCS,NIHSS and ADL after treatment in the two groups were obviously improved compared with before treatment,the differences were statistically significant (P<0.05 or P<0.01);moreover the above scores after treatment in the edaravone group were superior to those in the conventional treatment group,with statistical difference between them(P<0.05). The death rate in the edaravone group was lower than that in the conventional treatment group ,the difference was statistically sig-nificant[34.55%(19/55) vs. 55.10%(27/49),χ2=4.439,P=0.035]. Conclusion After complicating MODS in ACVD patients,the body is in oxidative stress status by the mechanisms of the inflammatory mediators,ischemic reperfusion injury,etc. giving the edaravone therapy as early as possible may eliminate the waterfall effect of free radicals ,plays its nerve protective effect and reduces the death rate.