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Dữ liệu thực tế về clazosentan trong liệu pháp kết hợp điều trị xuất huyết dưới nhện do phình mạch: một nghiên cứu tổng hợp hồi cứu đa trung tâm
Tóm tắt
Xuất huyết dưới nhện do phình mạch (aSAH) có thể dẫn đến co mạch não, có liên quan đáng kể đến bệnh tật và tử vong. Trong các nghiên cứu giai đoạn 3 mù đôi, có đối chứng giả dược, clazosentan làm giảm bệnh tật liên quan đến co mạch não và tử vong do tất cả nguyên nhân ở bệnh nhân aSAH. Chưa có báo cáo nào về hiệu quả lâm sàng của liệu pháp kết hợp clazosentan với một số loại thuốc khác. Ban đầu, chúng tôi đã khám phá hiệu quả của liệu pháp kết hợp clazosentan với cilostazol, statin và thuốc chống động kinh. Sau đó, chúng tôi đã đánh giá hiệu ứng kết hợp của fasudil vào liệu pháp kết hợp clazosentan cho bệnh nhân aSAH. Nghiên cứu hồi cứu quan sát đa trung tâm này bao gồm các bệnh nhân Nhật Bản mắc aSAH từ tháng 6 năm 2022 đến tháng 3 năm 2023. Kết quả chính là điểm số thứ bậc trên Thang điểm cải biến Rankin (mRS; khoảng 0–6, với điểm số cao hơn cho thấy khả năng khuyết tật lớn hơn) tại thời điểm xuất viện. Trong số 47 trường hợp (74,5% phụ nữ; tuổi trung bình 64,4 ± 15,0 năm) được điều trị bằng liệu pháp kết hợp clazosentan, có 29 trường hợp (61,7%) đạt được kết quả khả quan. Tổng thể, co mạch não xảy ra ở 16 trường hợp (34,0%), với bốn trường hợp (8,5%) phát triển thiếu máu cục bộ não muộn (DCI) liên quan đến co mạch. Cả huyết áp thấp và DCI liên quan đến co mạch đều có liên quan đến kết quả không thuận lợi tại thời điểm xuất viện. Fasudil được thêm vào trong 18 trường hợp (38,3%). Mặc dù có thêm fasudil vào liệu pháp kết hợp clazosentan, tỷ lệ co mạch não liên quan đến aSAH không giảm. Việc thêm fasudil vào liệu pháp kết hợp có liên quan đến phù phổi, co mạch và DCI liên quan đến co mạch, và các kết quả không thuận lợi. Liệu pháp kết hợp clazosentan có thể mang lại kết quả khả quan cho bệnh nhân aSAH nhằm ngăn ngừa DCI liên quan đến co mạch sau aSAH. Hiệu ứng thêm của fasudil vào liệu pháp kết hợp không cho thấy tác động đáng kể trong việc giảm co mạch liên quan đến aSAH hoặc cải thiện kết quả tại thời điểm xuất viện.
Từ khóa
#Xuất huyết dưới nhện #clazosentan #co mạch não #bệnh tật #tỷ lệ tử vongTài liệu tham khảo
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