Gao Yu, Zhang Yi, Li Zhuo, Ma Linlin, Yang Jing
Department of Hyperbaric Oxygen Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2020 Aug 14;99(33):e21822. doi: 10.1097/MD.0000000000021822.
Amantadine is currently recommended for use in patients of posttraumatic brain injury with unconsciousness. However, the application of amantadine in consciousness disturbance after cerebral hemorrhage has only been rarely reported. This allows for a further exploration of the role of amantadine in the treatment of PVS resulting from severe cerebral hemorrhage.Retrospective cohort study from 1/2015 to 7/2019 in Beijing Chaoyang hospital. We included adult patients treated with amantadine after severe cerebral hemorrhage in PVS. Primary outcome was time of consciousness recovery and Glasgow Out Scale scores after 5 months from onset. We compared characteristics and outcomes to a control cohort. matched on age, Coma Recovery Scale-Revised score, volume and location of hemorrhage.Among the 12 patients who received amantadine treatment, 6 patients regained consciousness (50%) after 5 months of disease onset, but were still severely disabled. Besides, the time for regaining consciousness was within 3 months of disease onset. The remaining 6 patients were still in a PVS. Compared with the amantadine group, the consciousness recovery rate (50% vs 33.3%, P = .68) after 5 months in the nested control group was not significantly different. The awakening time for patients in the amantadine group was earlier than the control group (100% vs 25%, P = .03).In this study, amantadine can accelerate the recovery of consciousness in patients following severe cerebral hemorrhage. We recommend further randomized controlled studies to determine the efficacy of amantadine.
金刚烷胺目前被推荐用于创伤后脑损伤昏迷患者。然而,金刚烷胺在脑出血后意识障碍中的应用报道较少。这使得进一步探索金刚烷胺在治疗严重脑出血所致植物状态中的作用成为可能。
2015年1月至2019年7月在北京朝阳医院进行的回顾性队列研究。我们纳入了在植物状态下接受金刚烷胺治疗的重度脑出血成年患者。主要结局是发病后5个月意识恢复时间和格拉斯哥预后评分。我们将其特征和结局与年龄、昏迷恢复量表修订版评分、出血量和出血部位相匹配的对照组进行比较。
在接受金刚烷胺治疗的12例患者中,6例(50%)在发病后5个月恢复意识,但仍重度残疾。此外,意识恢复时间在发病后3个月内。其余6例患者仍处于植物状态。与金刚烷胺组相比,嵌套对照组5个月后的意识恢复率(50%对33.3%,P = 0.68)无显著差异。金刚烷胺组患者的苏醒时间早于对照组(100%对25%,P = 0.03)。
在本研究中,金刚烷胺可加速重度脑出血患者意识的恢复。我们建议进一步开展随机对照研究以确定金刚烷胺的疗效。