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目的探讨颅内动脉瘤并心肌损伤机制,寻找防治方法。方法 59例颅内动脉瘤蛛网膜下腔出血并心肌损伤患者,分为实验组、对照组,颅内动脉瘤蛛网膜下腔出血无心肌损伤患者为空白对照组,实验组在手术治疗基础上应用右美托咪定抗交感活性,对照组及空白对照组采用手术及常规治疗。实验前、后1,3,5,7 d动态测定血浆去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)及脑型利钠肽(Brain Natriuretic Peptides,BNP)浓度。结果与空白对照组比较,颅内动脉瘤合并心肌损伤者,血浆平均NE(4.82±0.41 vs 2.90±0.59,P<0.05)、E(4.26±0.71 vs 2.87±0.57,P<0.05)浓度、BNP(5329.69±61.48 vs 1101.84±52.19,P<0.05)均明显升高,右美托咪定干预治疗后,实验组术后1 d NE、E、BNP开始下降,3～5 d恢复正常,对照组术后3 d,NE、E、BNP开始下降,5 d恢复正常,空白对照组则无变化。结论颅内动脉瘤并蛛网膜下腔出血合并心肌损伤与体内交感活性亢进有关,行抗交感治疗可改善心肌损伤。
Objective To investigate the mechanism of intracranial aneurysms and myocardial injury and to find out the prevention and treatment methods. Methods 59 cases of intracranial aneurysm subarachnoid hemorrhage and myocardial injury patients were divided into experimental group, control group, intracranial aneurysm without myocardial injury in patients with subarachnoid hemorrhage as a blank control group, the experimental group on the basis of surgical treatment The application of dexmedetomidine anti-sympathetic activity, control group and blank control group by surgery and conventional treatment. Plasma concentrations of norepinephrine (NE), epinephrine (E) and brain natriuretic peptide (BNP) were measured before, 1, 3, 5 and 7 days after the experiment. Results Compared with the blank control group, the average plasma levels of NE (4.82 ± 0.41 vs 2.90 ± 0.59, P <0.05), E (4.26 ± 0.71 vs 2.87 ± 0.57, P <0.05) (5329.69 ± 61.48 vs 1101.84 ± 52.19, P <0.05). After dexmedetomidine intervention, the levels of NE, E and BNP in the experimental group began to decrease on the 1st day after operation, and returned to normal on the 3rd to 5th day in the control group After 3 days, NE, E, BNP began to decline, return to normal after 5 days, but no change in the blank control group. Conclusion Intracranial aneurysms and subarachnoid hemorrhage with myocardial injury and sympathetic hyperactivity in vivo, anti-sympathetic treatment can improve myocardial injury.