替代剂量的甲泼尼龙治疗急性中重型颅脑创伤后肾上腺皮质功能减低的应用  

Application of alternative dose methylprednisolone in treatment of hypoadrenocorticism after acute severe and moderate traumatic brain injury

作　　者：楼永锋 张锦贤[1] 郭雷光 

机构地区：[1]浙江省浦江县人民医院,浦江322200

出　　处：《浙江创伤外科》2013年第6期774-778,共5页Zhejiang Journal of Traumatic Surgery

摘　　要：目的研究急性重型颅脑创伤病人中替代剂量地使用甲泼尼龙(methylprednisolone)联合甘露醇能否改善患者预后状况。方法将74位急性中重型颅脑外伤病人随机均分成A(GCS=7.57±2.97)、B(GCS=7.81±2.85)两组,然后按照GCS标准再将每组颅脑外伤病人按病情轻重分为中、重型两个亚组(即A1(中型颅脑损伤17人,GCS=10.35±1.13)、A2(重型颅脑损伤20人,GCS=5.20±1.75)、B1(中型颅脑损伤18人,GCS=10.33±1.11)、B2(重型颅脑损伤19人,GCS=5.42±1.70)),实验组A组病人在创伤后给予甲泼尼龙(1.0mg·kg-1·d-1)治疗,对照组B组病人给予同时间同样剂量的安慰剂治疗,疗程均为10天,其余诊疗经过,如手术及手术方式、营养支持治疗、脱水治疗以及其他用药、护理等情况无明显差异。结果经过治疗,实验组A1亚组病人10天后8例GCS评分≥12分,5例GCS评分9～12分,3例GCS评分3～8分,1例死亡,死亡率5.82%,GCS=11.697±3.40,与治疗前相比GCS评分未见明显统计学差异(P>0.05);实验组A2亚组病人10天后5例GCS评分≥12分,6例GCS评分9～12分,4例GCS评分3～8分,5例死亡,死亡率25.00%,GCS=10.46±3.30,与治疗前GCS相比具有统计学差异(P<0.01);对照组B1亚组病人10天后6例GCS评分≥12分,8例GCS评分9～12分,2例GCS评分3～8分,2例死亡,死亡率11.11%,GCS=11.06±2.56,与治疗前GCS相比无统计学差异(p>0.05);对照组B2亚组病人10天后2例GCS评分≥12分,5例GCS评分9～12分,6例GCS评分3～8分,7例死亡,死亡率36.84%,GCS=8.15±3.28,与治疗前GCS相比有统计学差异(P<0.01);治疗10天后A1组病人与B1组病人GCS评分比较不具有显著统计学差异(P>0.05),A2组病人与B2组病人GCS评分比较具有显著统计学差异(P<0.05)。结论在中型颅脑创伤病人的治疗中使用替代剂量的甲泼尼龙不能显著改善预后,但也不会使病情恶化;而在重型颅脑创伤病人的治疗中使用替代剂量的甲泼尼龙与未使用者相比能显著改善患者预后状况�Objective To study the application of alternative dose methylprednisolone combined with mannitol in the treatment of acute severe and moderate traumatic brain injury patients and evaluate its effect to the prognosis. Methods 74 acute severe and moderate traumatic brain injury patients were randomly divided into two groups： A（GCS=7.57±2.97）, B（GCS=7.81±2.85）. According to the GCS, each group was divided into two subgroups, the medium and severe subgroups： Al（17 medium,GCS=10.35±1.13）, A2（20 severe , GCS=5.20± 1 .75 ）, Bl（18 medium,GCS=10.33±1.11）, B2 （19 severe,GCS=5.42±1.70）. In group A, the patients were given methylprednisolone （1.0mg/kg/d）. In group B, the patients were given placebo as the same dose. The treatment course was 10 days. Other treatment methods, such as surgery and surgical methods, nutrition support therapy, dehydra- tion therapy and medication, attendance were no significant difference between two gruops. Results In group A1, 1 patient died, and the mortality was 5.82%, GCS=I 1.697±3.40 after treatment. Compared with the GCS before treatment, there was no significant difference （P〉0.05）. In group A2, 5 patient died, and the mortality rate was 25.00%, GCS=10.46_3.30 after treatment. Compared with the GCS before treatment, there was significant different （P〈0.01）. In group B1, 2 patient died, and the mortality rate was 11.11%, GCS=11.06_±2.56 after treatment. Compared with the GCS before treatment, there was no significant difference（P〉0.05）. In group B2, 7 patient died, and the mortality rate was 36.84%, GCS=8.15±3.28 after treatment. Compared with the GCS before treatment there was statistically significant different （P〈0.01）. There was no statistically significant difference in GCS between group A1 and B1 after the treatment. While between A2 and B2, there was sigaaificant difference in GCS （P〈0.05）. Conclusion The alter- native dose methylprednisolone can not significantly improve the prognosis in the moderate traumatic br

关 键 词：甲泼尼龙 颅脑创伤 格拉斯哥昏迷评分(GCS) 

分 类 号：R651.1[医药卫生—外科学]