早期血液净化治疗重型颅脑损伤的临床研究  

Clinical study on early application of continuous blood purification in the treatment of severe craniocerebral injury

作　　者：步玮[1] 赵庆林[1] 赵大巍[1] Bu Wei;Zhao Qinglin;Zhao Dawei(Department of Neurosurgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院神经外科,050051

出　　处：《中华实验外科杂志》2020年第1期152-154,共3页Chinese Journal of Experimental Surgery

摘　　要：目的研究早期血液净化治疗重型颅脑损伤的临床意义。方法将2013年2月至2018年2月河北医科大学第三医院收治的重型颅脑损伤患者85例按随机数字表法随机分为连续血液净化治疗组(试验组)42例和传统治疗组(对照组)43例。连续血液净化治疗组患者在传统治疗方法的基础上早期采用连续性血液净化治疗时间为7 d,传统治疗组应用传统的治疗方法,检测两组患者发病1 d和5 d血清肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)和神经丝蛋白H磷酸化亚型(pNF-H)。发病28 d随访两组的ApacheⅡ评分、格拉斯哥昏迷评分(GCS)评分、机械通气时间、重症监护病房(ICU)停留时间。发病6个月生存率等。使用SPSS 15.0软件进行统计分析,计量资料比较采用t检验,两组间生存率及生存质量比较采用χ^2检验。结果发病5 d试验组血清TNF-α(4.85±0.45)ng/L(t=6.890,P<0.05)、NSE(25.5±10.3)mg/L(t=4.610,P<0.05)和pNF-H(0.25±0.12)μg/L(t=5.430,P<0.05)发病28 d的ApacheⅡ评分12.10±4.81(t=2.080,P<0.05)、GCS评分10.45±3.25(t=-3.130,P<0.05)、机械通气时间(10.6±2.3)d(t=4.940,P<0.05)、ICU停留时间(9.0±3.5)d(t=2.510,P<0.05)均好于对照组,差异均有统计学意义。患者6个月生存率实验组76.19%明显高于对照组(χ^2=4.795,P<0.05),差异有统计学意义。恢复良好患者百分比试验组50%高于对照组(χ^2=2.105,P>0.05),差异无统计学意义。结论早期血液净化治疗提高了重型颅脑损伤患者的生存率及生活质量,具有很高的临床应用价值。Objective To study the clinical significance of early usage of continuous blood purification on the treatment of severe craniocerebral injury.Methods 85 Patients with severe brain injury admitted in our department were randomly divided into continuous blood purification treatment group(experiment group,42 patients)and conventional treatment group(control group,43 patients).patients in continuous blood purification treatment group were treated by continuous blood purification and traditional treatment from 1-7 days,traditional treatment group only were treated by the traditional treatment methods.To detect tumor necrosis factor(TNF)-α,neuron specific enolase(NSE)and pNF-H in 1 and 5 day.On the 28th day ApacheⅡscore,ICU stay time and GCS score of two groups.To detect 6 months survival rate of two groups.Spss15.0 software was used for statistical analysis,The measurement data are subject to T test The survival rate and quality of life comparison between the two groups was compared byχ^2 test,P<0.05 was considered statistically significant.Results Incidence of 5 days of TNF-α(4.85±0.45)ng/L(t=6.890,P<0.05),NSE(25.5±10.3)mg/L(t=4.610,P<0.05)and pNF-H(0.25±0.12)μg/L(t=5.430,P<0.05),When the 28 days after injury,Apache-Ⅱscore 12.10±4.81(t=2.080,P<0.05),GCS score 10.45±3.25(t=-3.130,P<0.05),mechanical ventilation time(10.6±2.3)d(t=4.940,P<0.05)and ICU stay time(9.0±3.5)d(t=2.510,P<0.05)of experiment group are better than the control group(P<0.05).Difference was statistically significant.Experimental group is significantly higher than control group in six months survival patients76.19%(χ^2=4.795,P<0.05).Experimental group with good recovery percentage50%(χ^2=2.105,P>0.05).Conclusion Early continuous blood purification treatment improves the survival rate and quality of life of patients with severe brain injury which have higher clinical value.

关 键 词：连续血液净化 重型颅脑损伤 早期治疗 

分 类 号：R651[医药卫生—外科学]