| Cerebral infarction,also known as ischemic stroke,refers to the disorder of cerebral blood supply caused by various reasons,which leads to ischemia,anoxia and necrosis of local brain tissue,resulting in neurological deficits.Patients with anterior circulation cerebral infarction will have obvious high-level neurological deficits,such as consciousness disorders,limb movement disorders,language disorders,cognitive dysfunction,etc.Cerebral infarction can cause damage to the central nervous system through energy metabolism disorder,acidosis,oxidative stress,nitriding stress,Ca2+ overload,mitochondrial dysfunction,excessive release of excitatory amino acids,inflammatory reaction,destruction of blood-brain barrier and other mechanisms.The release of endogenous opioid peptides will aggravate this secondary damage,resulting in changes in language,limb movement and consciousness.The patients’ ability of daily living will also decrease significantly.Objective: To evaluate the therapeutic effect of nalmefene,an opioid receptor antagonist,on acute moderate anterior circulation cerebral infarction.Methods: Totally 55 acute moderate anterior circulation cerebral infarction patients diagnosed at our hospitai from April 2019 to October 2019 were enrolled in this study and randomly divided into observation group and control group.Both groups were given salvianolate and edaravone,butylphthalide and so on for improving circulation,nerve nutrition and symptomatic treatment.Patients with relatively severe cerebral hemisphere infarction with a maximum diameter of more than 3cm in the two groups were divided into group A,mannitol and glycerol fructose dehydration treatment were given.Patients with relatively mild cerebral hemisphere infarction with a maximum diameter less than 3cm in the two groups were divided into group B,without mannitol and glycerol fructose dehydration treatment.In group A,15 patients were assigned to the observation group and 13 patients to the control group.In group B,14 patients were assigned to the observation group and 13 patients to the control group.The observation group was given 0.20 mg of nalmefene dissolved into 50 ml of 0.9% sodium chloride solution for intravenous drip for 14 days on the basis of conventional treatment.To evaluate the National Institute of Health Stroke Scale score(NIHSS)and Glasgow Coma Scale(GCS)before and 14 days after treatment and Barthel Index score and modified Rankin Scale(m RS)before and 14 days,30 days and 90 days after treatment and carry out statistical processing.Results:(1)In group A,the GCS score of observation group is 12.40±2.16 before medication,while the control group is 13.31±2.09.P>0.05.The GCS score changes in the observation group is 2.00±2.85 after medication of 14 days,while the control group is 1.07±1.97.P>0.05.In group B,the GCS score of observation group is 14.62±1.38 before medication,while the control group is 14.79 ± 0.80.P>0.05.The GCS score changes in the observation group is 0.38±1.38 after medication of 14 days,while the control group is 0.21 ± 0.80.P>0.05.(2)In group A,the NHISS score of observation group is 12.87±2.17 before medication,while the control group is 11.92±2.69.P>0.05.The NHISS score changes of observation group is 1.80±2.07 after medication of 14 days,while the control group is 1.61±2.22.P>0.05.In group B,the NHISS score of observation group is 9.77± 3.32 before medication,while the control group is 10.14 ±3.32.P>0.05.The NHISS score changes of observation group is 1.31±2.28 after medication of 14 days,while the control group is 1.29±1.73.P>0.05.(3)In group A,the Barthel Index score of observation group is 17.00±11.92 before medication,while the control group is 19.23 ±13.51.P>0.05.The Barthel Index score changes of observation group is 7.67±7.29 after medication of 14 days,while the control group is 6.92±11.28.P>0.05.The Barthel Index score changes of observation group is 27.00 ± 7.02 after medication of 30 days,while the control group is 18.85±12.44.P<0.05.The Barthel Index score changes of observation group is 44.00±6.60 after medication of 90 days,while the control group is 33.85±12.27.P<0.05.In group B,the Barthel Index score of observation group is 34.62±12.49 before medication,while the control group is 35.36±15.37.P>0.05.The Barthel Index score changes of observation group is 6.54±7.46 after medication of 14 days,while the control group is 4.64±9.29.P>0.05.The Barthel Index score changes of observation group is 25.00 ± 9.35 after medication of 30 days,while the control group is 14.29±8.74.P<0.05.The Barthel Index score changes of observation group is 43.46±11.79 after medication of 90 days,while the control group is 31.07±8.13.P<0.05.(4)In group A,the m RS score of observation group is 5(5,5)before medication,while the control group is 5(4,5).P>0.05.The m RS score changes of observation group is 0(0,1)after medication of 14 days,while the control group is 0(0,0).P>0.05.The m RS score changes of observation group is 1(1,1)after medication of 30 days,while the control group is 0(0,1).P<0.05.The m RS score changes of observation group is 2(2,2)after medication of 90 days,while the control group is 1(1,2).P<0.05.In group B,the m RS score of observation group is 4(4,5)before medication,while the control group is 4(4,5).P>0.05.The m RS score changes of observation group is 0(0,1)after medication of 14 days,while the control group is 0(0,1).P>0.05.The m RS score changes of observation group is 1(1,2)after medication of 30 days,while the control group is 0.5(0,1).P<0.05.The m RS score changes of observation group is 2(2,2.5)after medication of 90 days,while the control group is 1(1,2).P<0.05.Conclusion:(1)Opioid receptor antagonist nalmefene can improve the ability of daily living in patients with acute moderate anterior circulation cerebral infarction.(2)Nalmefene can improve the recovery of long-term neurological function in patients with acute moderate anterior circulation cerebral infarction.(3)Nalmefene can improve the prognosis of the patients. |
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