Clinical Efficacy Of Nalmefene In Middle Artery Cerebral Infarction

Cerebral infarction is a common type of cerebrovascular disease, and the middle cerebral artery infarction with the occupancy of almost 10% is a severe type of cerebral infarction. The area of the middle cerebral artery infarction is very large. Besides the normal clinical feature of cerebral infarction, the middle cerebral artery infarction can show a accelerating progressing and always with conscious disturbances and always leave obvious sequela. At the same time, endogenous mediators, ischemia, oxygen-poor and inflammatory reactions can cause the secondary lesion of central nervous system. The release of endogenous mediators especially endogenous opioid peptide will aggravate the secondary lesion, and lead to dysphonia, dyskinesia, conscious disturbance even narcosis.This issue showed the research progress of opiod peptide and opium receptor, as well as the pharmacological action and neural function of opiate receptor antagonist nalmefene. At the same time, 27 middle cerebral artery infarction patients diagnosed at the First Hosptial of Jinlin University form December 2009 to March 2011 were enrolled in this study. We treated some of the patients by nalmefene to show the clinical effect by observing the change of the patients'conscious state, paralysis recovering and cephalic CT.Objective: To analyze the phannaco mechanism of opium receptor and the neural effects of opiate receptor antagonist, assess the clinical effects and prognosis influence of nalmefene treated for middle cerebral artery infarction.Methods: Totally 27 middle cerebral artery infarction patients diagnosed at the First Affiliated Hospital of JiLin University from December 2009 to March 2011 were enrolled in this study and divided to treatment group and control group. Patients of both groups were treated by mannite, mannitol, xueshuantong, sodiym cytidine triphosphate and so on for dehydration, improving circulation, nerve nutrition and symptomatic treatment. Treatment group were treated by nalmefene by the dose of 0.20mg dissolved into 0.9% physiological saline semidaily besides the base of basic treatment. Before treatment and after 15 days, to analysis the GCS, NIHSS and countercheck cephalic CT and to assess therapeutic efficacy and the change of CT.Results:①The GCS score of treatment group is 9.02±3.19 before medication and 12.09±4.23 after medication. The control group is 9.15±3.78 before medication and 10.88±4.26 after medication. P<0.05.②The NIHSS score of treatment group is 24.17±4.38 before medication and 15.02±4.06 after medication. The control group is 23.75±3.79 before medication and 18.48±4.17 after medication. P<0.05.③In nalmefene treatment group, the effective rate is 86.67%, the ineffective is 13.33%, and the death rate is 13.33%. In control group, the effective rate is 66.67%, the ineffective is 33.33%, and the death rate is 25.00%. P<0.05.Conclusion:①Opiate receptor antagonist nalmefene can improve the neurologic impairment of middle cerebral artery infarction.②Nalmefene can change the cephalic CT of middle cerebral artery infarction into sulus-gyrus expression, and partly regain the blood supply, this may be caused by the function of neuroprotection and establishment of collateral circulation of nalmefene.③Nalmefene can improve the prognosis of the patients.