早期腰大池持续引流联合硫酸镁治疗弥漫性轴索损伤42例  

Diffuse axonal injury treated by continued lumbar cerebrospinal fluid drainage early combined with magnesium sulfate for 42 cases

作　　者：史立信 张文超 王传海 张林燕 孙夏青 

机构地区：[1]清河县人民医院神经外科,河北054800

出　　处：《脑与神经疾病杂志》2015年第6期434-440,共7页Journal of Brain and Nervous Diseases

摘　　要：目的 观察早期腰大池持续引流联合硫酸镁治疗弥漫性轴索损伤的临床疗效。方法 将弥漫性轴索损伤患者84例随机分成联合治疗组和常规治疗组,每组42例。常规治疗组予保持呼吸道通畅,早期静脉应用尼莫同,神经节苷脂及纳洛酮,降低颅内压、改善微循环,维持水电解质、酸碱平衡及营养支持处理,病情稳定后进行高压氧、针灸及理疗等康复治疗。联合治疗组在常规治疗的基础上加用早期腰大池持续引流10~14d,联合25%硫酸镁（用量按0.3~0.4ml·kg^-1·d^-1计算）缓慢静脉滴注,治疗7~10d。观察两组患者治疗效果。结果 两组比较,联合治疗组患者恢复良好率、病床周转率明显高于常规治疗组;气管切开、肺部感染、住院天数及住院费用四项明显低于常规治疗组,以上差异均有统计学意义（P〈0.05）。结论 该方法明显优于传统治疗方法,疗效肯定,可促进神经功能恢复,改善患者预后,有效降低肺部感染和气管切开的发生率,减少患者住院天数及住院费用,缩短病程,值得在临床工作中推广使用。Objective To assess the clinical efficacy of continued lumbar cerebrospinal fluid drainage （ CLCFD） early combined with magnesium sulfate on diffuse axonal injury （ DAI） .Methods 42 cases of DAI were randomly divided into combined treatment group and conventional treatment group, 42 cases respectively.The patients from conventional treatment group were kept air way unobstructed, nimotop,ganglioside and naloxone were intravenous applied early, reduced intra-cranial pressure,micro-circulation was improved, maintained the balance of water and electrolyte, as well as acid-base balance, nutritional support, and so on.Rehabilitation treatments such as hyperbaric oxygen, acupuncture and physical therapy were used after the condition became stable.On the basis of conventional treatment, the patients from combined treatment group were added CLCFD early for 10-14 days, combined with 25%magnesium sulfate （dosage by 0.3-0.4ml·kg^-1·d^-1 calculation） slow quiet drop for the treatment of 7-10 days. The treatment effect of the two groups were compared.Results The better recovery rate and bed turnover rate of combined treatment group were higher and the cut open, pulmonary infection, hospital stay, and hospitalization expenses were lower than that of the conventional treatment group .The differences were statistically significant （ P〈0.05） .There were no statistically significant differences between the complications and comparison of the results of the follow-up of the two groups （P〉0.05）.Conclusion This method is obviously superior to the traditional treatment method, the curative effect is certain.It can promote the recovery of nerve function, improve the prognosis of the patients, effectively reduce the pulmonary infection, incidence of tracheotomy and reduce length of hospital stay and hospital costs, shorten the course of disease, reduce the cost of nursing staff, improve the turnover rate of hospital beds, increase the economic benefits and social benefits of the hospital, which is worthy of prom

关 键 词：腰大池持续引流 弥漫性轴索损伤 硫酸镁 临床观察 

分 类 号：R741.04[医药卫生—神经病学与精神病学]