唑吡坦对脑损伤植物状态患者促醒疗效的观察  

Efficacy of zolpidem in promoting awakening from persistent vegetative state in patients with brain injury

作　　者：蔡坤皓[1] 刘丽君[1] 戴黎萌[1] 陈东[1] 徐菲[1] 万勇[1] 杜波[1] 赵永阳[1] 

机构地区：[1]广东省深圳市人民医院、暨南大学第二临床医学院神经外科,518020

出　　处：《中华神经医学杂志》2008年第11期1174-1176,共3页Chinese Journal of Neuromedicine

摘　　要：目的观察非常规促醒药物唑吡坦对脑损伤昏迷植物状态患者的促醒作用，分析该作用是否存在干预时间相关性。方法采用单光子发射型计算机体层摄影技术观察7例服用唑吡坦的持续性植物状态患者服药0．5h前后及1周后^99Tcm-双半光乙酯（ECD）脑灌注显像．做可视化分析；应用脑状态监测仪（CSM）进行检测，对比用药前后脑状态指数、肌电指数、爆发抑制指数的变化；观察患者临床指标变化，包括语言功能、肢体运动功能、肌张力、睡眠质量等的变化。结果（1）患者服药后脑状态指数、肌电指数均高于服药前爆发抑制指数低于用药前，差异均有统计学意义（P〈0．05）。（2）服药后7例患者脑损害区血流较服药前明显增加。（3）7例患者中3例成功促醒，表现为服药后0．5h能与家人及医生进行简单的交流，用药后第2天便能做简单的数学运算，下肢可遵嘱做屈曲运动，其中1例原有的肢体震颤及扭转痉挛明显缓解；余4例肌张力及睡眠质量改善。结论唑吡坦能恢复部分脑损害持续性植物状态患者的脑功能，脑功能的改善与服药时间长短无关，脑功能的改善是“一步到位”而非“逐步改善”。Objective To investigate the effect of zotpldem m promoting awakening persistent vegetative state in patients with brain injury and analyze the relation between the timing of drug administration and the awakening of the patients. Methods Brain ^99mTc-ethyl cysteinate dimer （^99mTc.ECD） single-photon emission computed tomography （SPECT） was performed in 7 patients in persistent vegetative state following brain injury 30 rain before and 30 min and 7 days after treatment with 10 mg zolpidem administered through a nasogastric tube. Visual analysis of cerebral perfusion changes in the injured brain regions after the treatment was performed. A cerebral state monitor was used to observe the changes in the cerebral state index, electromyogram index, and burst suppression ratio, and the patients＇ linguistic function, motor function of the limbs, muscular tension and sleeping were also monitored. Results After the treatment, the cerebral state index and electromyogram index were significantly increased （P〈0.05） and the burst suppression ratio significantly lowered （P〈0.05）; cerebral perfusion in the injured brain regions was significantly improved in all the patients as compared with that before treatment. Awakening was achieved in 3 patients, who were capable of simple communication30 rain after zolpidem administration, and of simple calculations and lower limb flexion and extension 2 days later. The symptom of limb tremor was significantly relieved in one of the awakened patients. Muscle spasm was significantly relieved and sleep cycle improved in the other 4 patients. Conclusion Zolpidem is effective to restore the brain function in some patients in persistent vegetative state following brain injuries. Zolpidem-induced brain function recovery is not related to the time length after the administration, and the effect is instant instead of being gradual.

关 键 词：唑吡坦 颅脑损伤 昏迷 

分 类 号：R741[医药卫生—神经病学与精神病学]