[Pharmacological neuroprotection for intracerebral hemorrhages in patients with polyvascular disease]

To evaluate the efficacy of pharmacological neuroprotection with protein, peptide and metabolic drugs as a part of basic intensive therapy for intracerebral hemorrhages in patients with polyvascular disease (PolyVD).

Twenty-eight male patients with PolyVD referred to surgical treatment of intracerebral hemorrhages, who were on mechanical ventilation and received basic intensive care, were included in a single center prospective observational study. All patients were assigned either to routine daily i/v infusions of 10 ml cytoflavin in 0.9% sodium chloride solution for 10 days (n=12) or 0,2 mg daily of cellex subcutaneously (n=16). Central hemodynamics, intracranial pressure, and continuous indicators of the linear velocity of blood circulation were assessed. All patients underwent SOFA scoring. The markers of brain damage, including protein S-100-β (ng/l), antioxidant enzyme activity of superoxide dismutase (SOD) U/gr/Hb), glutathione peroxidase (U/gr/Hb) in the systemic circulation and jugular vein on the lesion side were determined. The length of stay in the intensive care unit and the number of nights were calculated. Mortality was assessed in both groups.

Intracranial hypertension in both groups tended to subnormal parameters by 3-5 days. Vasospasm was reduced more rapidly (by the 3rd day) in the cytoflavin group compared to the cellex group (174 [152; 189] vs. 205 [182; 219], respectively). The latter demonstrated the less extent of cerebral damage according to S100 protein concentration. A comparative analysis showed that the antioxidant activity was significantly higher in the cytoflavin group. The cellex group demonstrated a pronounced trend towards the regression of neurological deficit on the NIHSS (p=0,025). The number of fatal outcomes and nights spent in the ICU were similar in both groups. The in-hospital stay was insignificantly shorter in the cellex group.

It is recommended to add both antioxidant and neuropeptide pharmacological neuroprotectors in the routine intensive therapy for treating intracerebral hematomas in patients with PolyVD after surgical management.