温阳益气法对重型颅脑损伤患者亚低温治疗期的辅助作用  

The subsidiary effect of Wenyang Yiqi method on patients with severe traumatic brain injury under mild hypothermia therapy

作　　者：王冠[1,2] 曹德晨[3] 孙宏声[3] 董琨[2] 王雪岩[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津中医药大学第二附属医院,天津300150 [3]天津市环湖医院神经外科,天津300060

出　　处：《中国中西医结合急救杂志》2015年第5期449-452,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目（81303091）;天津市中医药管理局中医中西医结合科研专项课题（13103）

摘　　要：目的 观察温阳益气法对重型颅脑损伤亚低温治疗期患者的神经保护辅助作用.方法 采用前瞻性研究方法,将53例重型颅脑损伤亚低温治疗患者按双盲随机原则分为对照组26例、观察组27例.两组均接受常规西医治疗联合亚低温治疗;观察组同时应用温阳益气法代表药物参附注射液100 mL加入5%葡萄糖注射液500 mL中静脉滴注（静滴）,每日1次,当亚低温治疗结束后停用参附注射液.观察两组治疗1、2、3、4、5、6、7 d患者颅内压（ICP）水平的变化及治疗前和治疗2、4、6 d患者脑脊液（CSF）中人S100B蛋白（S-100B）、乳酸脱氢酶（LDH）、肌酸激酶（CK）含量的变化,并记录治疗前及治疗后3、5、7、14、28 d格拉斯哥昏迷评分（GCS）,治疗后28 d、3个月的格拉斯哥预后评分（GOS评分）,以及并发症发生率.结果 随着治疗时间延长,两组治疗后ICP均逐渐升高,于治疗后4 d达峰值,以后进行性下降,治疗5 d开始观察组ICP水平显著低于对照组〔ICP（mmHg,1 mmHg=0.133 kPa）：16.11±1.23比18.73±1.42〕,并持续到治疗7 d（14.17±0.80比16.94±1.00,P〈0.05）;两组S-100B进行性下降,于治疗2 d开始观察组明显低于对照组（μg/L：1.21±0.43比1.86±0.57,P〈0.05）,并持续到治疗6 d（0.40±0.09比0.94±0.15,P〈0.05）;LDH、CK于治疗2 d达峰值,以后开始下降,于治疗4 d起观察组明显低于对照组〔LDH（U/L）：63.43±12.21比80.11±14.34,CK（U/L）：52.41±14.14比88.37±12.21,均P〈0.05〕,治疗6 d两组比较差异仍有统计学意义.两组治疗前GCS评分比较差异无统计学意义（P〉0.05）,治疗后两组GCS评分进行性改善,于治疗后14 d开始观察组GSC评分明显高于对照组（分：11.74±1.24比9.41±2.11,P〈0.05）,并持续到治疗后28 d（分：12.68±2.51比10.67±1.99,P〈0.05）;治疗后28 d两组患者GOS评分比较差异无统计学意义（分：2.35±0.16比2.43±0.22,P〉0.05）,3个月后观察组GOS评分明Objective To observe the neural protective subsidiary effect of Wenyang Yiqi method on patients with severe traumatic brain injury under mild hypothermia therapy.Methods A prospective study was conducted in which 53 patients with severe traumatic brain injury treated by mild hypothermia were randomly divided into control group （26 cases） and observation group （27 cases）. All the patients in the two groups received conventional western treatment combined with mild hypothermia therapy. In the observation group, additionally was given the representative drug of Wenyang Yiqi method, Shenfu injection 100 mL mixed into 5% glucose 500 mL intravenous drip once a day. At the end of mild hypothermia, the Shenfu injection was stopped. After treatment, the changes of intracranial pressure （ICP） on 1 （the day the treatment began）, 2, 3, 4, 5, 6 and 7 days and the indexes levels, including S-100B, lactate dehydrogenase （LDH） and creatinkinase （CK） in the cranial spinal fluid （CSF） before treatment and 2, 4, 6 days after treament （CSF） were observed. The Glasgow coma score （GCS） before treament and 3, 5, 7, 14, 28 days after treament, and Glasgow outcome scale （GOS） on 28 days and 3 months after treatment were recorded, and the incidences of complications were calculated at the end of therapy.Results After treatment with the prolongation of therapeutic time, the levels of ICP were gradually increased in two groups and reached the peak values on the 4th day, then beganto fall, and on the 5th day it was significantly lower in observation group than that in control group [ICP （mmHg, 1 mmHg = 0.133 kPa）： 16.11±1.23 vs. 18.73±1.42], persisting the same situation to the 7th day （14.17±0.80 vs. 16.94±1.00,P 〈 0.05）. The levels of S-100 B in the two groups were progressively decreased after the treatment, on the 2nd day it was significantly lower in observation group than that in control group （μg/L： 1.21±0.43 vs. 1.86±0.57, P 〈 0.05）, also persisting to the 6th day （

关 键 词：亚低温 颅脑损伤 颅内压 温阳益气法 参附注射液 

分 类 号：R651.15[医药卫生—外科学]