亚低温联合大剂量纳洛酮治疗外伤性急性弥漫性脑肿胀的临床研究  

Clinical Study of Treatment with Mild Hypothermia and High Dose Naloxone for Post-traumatic Acute Diffuse Brain Swelling

作　　者：廖圣芳[1] 王汉东[1] 

机构地区：[1]南方医科大学临床医学院神经外科,江苏南京210002

出　　处：《临床军医杂志》2008年第5期701-704,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨亚低温联合大剂量纳洛酮治疗外伤性急性弥漫性脑肿胀(PADBS)的机制与疗效。方法选择伤后12 h内入院的PADBS患者51例(治疗组)接受亚低温联合大剂量纳洛酮治疗,同期入院常温下未用纳洛酮治疗的同类患者51例作为对照组;所有患者其他治疗措施均基本相同。同时监测病人的生命体征,血浆β-内啡肽(β-EP)均值、颅内压(ICP)、脑灌注压(CPP)、血糖、血乳酸、血气、血电解质。均于伤后3个月时根据GOS评估法判定疗效。结果与对照组相比,亚低温联合大剂量纳洛酮治疗组病人伤后早期的血浆β-EP均值、高ICP、高血糖、高乳酸血症分别明显下降(P<0.01),低CPP明显上升(P<0.01);生命体征、血气及血电解质差异无统计学意义;无严重并发症。将恢复良好、中残、重残合称为治疗有效,将植物生存、死亡合称为治疗无效。治疗组治疗有效率显著高于对照组(P<0.05),而治疗无效率显著低于对照组(P<0.05)。治疗组觉醒天数显著短于对照组(P<0.01)。结论PADBS患者早期应用亚低温联合大剂量纳洛酮治疗可明显提高临床疗效,缩短昏迷时间,无严重并发症。Objective To study the therapeutic mechanism and the effect of mild hypothermia and high dose naloxone on the patients with post-traumatic acute diffuse brain swelling （PADBS）. Methods A total nf 102 patients with PADBS [ Glasgow coma scale （GOS） score ≤ 8 on admission t were randomly divided into trial group （ n = 51 ） and control group （ n = 51 ）. The trial group was treated with mild hypothcn, ia plus high dose naluxone arid the control group treated ureter the condition of normal temperature without naloxonc. Meantime, tile parameters, such as vital signs, blood β-endorphin （β-EP） , intraeranial pressure （ICP） , cranial perfusion pressure （CPP） , blood glucosc, blood lactate, blood gas values, blood eleetrolytes, were mcasured. According to GOS scoring, the prognosis of the patients was evaluated. Results In comparison with control group, increased blood β-EP, ICP, and blood glucose and lactate decreased significantly （ P 〈0.01 ） , and decreased CPP significantly increased （ P 〈 0.01 ）. In the trial group, 21 cases were treated effectivcly and 30 eases treated without effect, while in the control group, the counterparts were 11 and 40, respectively. There were significant differenccs between the two groups （ P 〈 0.05 ）. The time of awakening or consciousness recovery was shortener in the trial group than in the control group （ P 〈 0.01 ）. Conclusion The condition of the patients with PADBS can he improved by administration of mild hypothermia and high dose naloxone.

关 键 词：外伤性急性弥雌性脑肿胀(PADBS) 亚低温 纳洛酮 Β-内啡肽 预后 

分 类 号：R742.7[医药卫生—神经病学与精神病学]