盐酸纳洛酮在颅脑外伤后持续性植物状态中的临床应用  

CLINICAL STUDY OF THE EFFECT AND POTENTIAL MECHANISM OF NALOXONE ON PATIENTS WITH PERSISTENT VEGETABLE STATE FOLLOWED BY HEAD TRAUMA

作　　者：陆华[1] 陈革[1] 吴卫江[1] 周建宏[1] 唐志放[1] 蒋云召[1] 陆爻忠[1] 孙钧铭[1] 苗宗宁[1] 钱永峰[1] 

机构地区：[1]江苏省无锡市第三人民医院神经外科,江苏无锡214041

出　　处：《实用临床医药杂志》2004年第4期49-52,共4页Journal of Clinical Medicine in Practice

基　　金：无锡市社会发展计划项目 (HSZ2 0 0 2 0 0 7);无锡市卫生局十五重大攻关项目 (SWKY0 210 )

摘　　要：目的　探讨盐酸纳洛酮在颅脑外伤后持续性植物状态 (PVS)中的治疗效果及可能机制。方法　 45例颅脑外伤后PVS患者随机分成常规治疗对照组、小剂量纳洛酮治疗组和大剂量纳洛酮治疗组 ,治疗组在常规治疗基础上加用纳洛酮 2 4～9 6mg/d ,连续治疗 1～ 2个月。 3个月后比较各组意识转清率、GOS恢复良好率及PVS预后评分 ,观察治疗前后脑脊液 β 内啡肽 ( β EP)含量变化 ,测定脑干听觉诱发电位 (BAEP)、体感诱发电位 (SEP) ,比较经颅多普勒 (TCD)大脑中动脉血流速度的变化。结果　大剂量纳洛酮治疗组 3个月后脑脊液 β EP水平下降 ,BAEP的Ⅰ～Ⅴ波峰潜伏期 (Ⅰ～ⅤIPL)、正中神经SEP的N1 3～N2 0 峰间潜伏期 (N1 3～N2 0 IPL)缩短 ,大脑中动脉血流增快 ,其意识转清率、GOS恢复良好率及PVS疗效评分明显提高。结论　纳洛酮通过降低脑脊液β EP水平 ,增加脑血流 ,改善微循环 ,促进神经传导功能恢复 。Objective: To study the effect and potential mechanism of Naloxone in the treatment for the persistent vegetable state (PVS) followed by head trauma. Methods: 45 patients with post、traumatic PVS were divided into the control group with the routine therapy, the small dose Naloxone treatment group and the large dose Naloxone treatment group. Besides the routine therapy, Naloxone 2.4～9.6 mg/d was used in the treatment group which lasted for one to two months. Three months later, the changes of consciousness, the recovery rate and PVS outcome scale were compared among these groups and the changes of the cerebral、spinal fluid concentration of the β、EP, brain stem auditory evoked potentials(BAEP), median nerve somatosensory evoked potentials(SEP) and the middle cerebral artery(MCA) blood flow velocity measured through trans、cranial Doppler(TCD). Results: Three months later after the large dose Naloxone treated, the level of β、EP of the cerebral、spinal fluid decreased, BAEP conducting time(Ⅰ～Ⅴ IPL) and median nerve SEP latency time(N_(13)～N_(20) IPL) shortened and the MCA blood flow velocity increased. The consciousness, the recovery rate and the PVS outcome scale improved significantly. Conclu、sions: Naloxone, to a certain degree, can make the consciousness of patients with PVS improved through lowering the level of β、EP, increasing the cerebral blood flow, improving the microcirculation, and enhancing the recovery of the patients′ neuro、function.

关 键 词：颅脑外伤 PVS 临床应用 纳洛酮 持续性植物状态 Β-EP 治疗组 恢复 水平 正中神经 

分 类 号：R651.15[医药卫生—外科学] R743[医药卫生—临床医学]