纳络酮治疗急性重型颅脑损伤的疗效及其对患者血浆内皮素含量的影响
|
摘要
目的探讨纳络酮治疗急性重型颅脑损伤的疗效及其对患者血浆内皮素(ET)含量的影响。方法选择2016年1月至2017年10月期间解放军第174医院急诊医学科收治的64例急性重型颅脑损伤患者为研究对象,根据随机数表法分为观察组与对照组,每组32例,对照组予脱水降颅压等常规治疗,观察组联合应用纳洛酮治疗,疗程为14 d,比较两组患者治疗前及治疗3 d后血浆ET水平的变化;比较两组患者清醒时间及治疗后日常生活能力(ADL)、神经功能缺损程度评分(NIHSS)水平。结果治疗3 d后,观察组患者的血浆ET水平为(76.4±15.3) pg/mL,明显低于对照组的(95.2±17.1) pg/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的苏醒时间为(12.3±2.3) d,明显短于对照组的(16.4±3.1) d,且观察组ADL评分为(68.4±10.2)分,NIHSS评分为(9.2±1.8)分,与对照组的(56.6±9.4)分、(11.0±2.2)分比较,差异均有统计学意义(P<0.05)。结论纳洛酮治疗急性重型颅脑损伤有利于患者血浆内皮素水平的降低,明显促进颅脑损伤患者神经功能的恢复,提高日常生活能力。
Objective To investigate the effect of naloxone in the treatment of acute severe craniocerebral injury and its effect on the plasma endothelin(ET) content. Methods During January 2016 and October 2017, 64 patients with acute severe craniocerebral injury in Department of Emergency Medicine, 174 thHospital of Chinese PLA were selected and divided into observation group and control group according to random number table, with 32 patients in each group. The control group was treated with dehydration for reducing intracranial pressure and other conventional treatment, while the observation group used naloxone additionally, for 14 days. The change of plasma ET in the two groups was compared before treatment and 3 days after treatment, as well as recovery time after treatment, and Activity of Daily Living(ADL) Scale, and the National Institutes of Health Stroke Scale(NIHSS) score. Results At 3 days after treatment, plasma ET in observation group was(76.4±15.3) pg/mL, significantly lower than(95.2±17.1) pg/mL in the control group(P<0.05). After treatment, the recovery time in observation group was(12.3 ± 2.3) d, significantly shorter than(16.4±3.1) d in the control group, and the ADL score and NIHSS score of observation group was(68.4±10.2),(9.2±1.8),as compared with(56.6±9.4),(11.0±2.2) in the control group(P<0.05). Conclusion Naloxone in the treatment of acute severe craniocerebral injury is conducive to the reduction of plasma ET, which can significantly improve the recovery of neurological function and daily life ability.
Objective To investigate the effect of naloxone in the treatment of acute severe craniocerebral injury and its effect on the plasma endothelin(ET) content. Methods During January 2016 and October 2017, 64 patients with acute severe craniocerebral injury in Department of Emergency Medicine, 174 thHospital of Chinese PLA were selected and divided into observation group and control group according to random number table, with 32 patients in each group. The control group was treated with dehydration for reducing intracranial pressure and other conventional treatment, while the observation group used naloxone additionally, for 14 days. The change of plasma ET in the two groups was compared before treatment and 3 days after treatment, as well as recovery time after treatment, and Activity of Daily Living(ADL) Scale, and the National Institutes of Health Stroke Scale(NIHSS) score. Results At 3 days after treatment, plasma ET in observation group was(76.4±15.3) pg/mL, significantly lower than(95.2±17.1) pg/mL in the control group(P<0.05). After treatment, the recovery time in observation group was(12.3 ± 2.3) d, significantly shorter than(16.4±3.1) d in the control group, and the ADL score and NIHSS score of observation group was(68.4±10.2),(9.2±1.8),as compared with(56.6±9.4),(11.0±2.2) in the control group(P<0.05). Conclusion Naloxone in the treatment of acute severe craniocerebral injury is conducive to the reduction of plasma ET, which can significantly improve the recovery of neurological function and daily life ability.
引文
[1]徐冬花.综合康复护理对颅脑损伤患者肢体运动、神经功能和生存质量的影响[J].中国药业, 2011, 20(21):78-79.
[2]陆弘盈,覃重桥,余松祚,等.亚低温治疗对重型颅脑损伤患者血浆内皮素的影响[J].微创医学, 2016, 11(4):509-512.
[3] HSU YY, JONG YJ, LIN YT, et al. Nanomolar naloxone attenuates neurotoxicity induced by oxidative stress and survival motor neuron protein deficiency[J]. Neurotox Res, 2013, 25(3):262-270.
[4]李莉.肢体功能训练对颅脑损伤患者肢体功能、神经功能和日常生活能力的影响[J].西部中医药, 2014, 27(12):124-125.
[5]余国亮.尼莫地平对高血压脑出血急性期患者神经功能缺损程度评分、脑血流动力学参数及临床疗效的影响[J].中国基层医药,2017, 24(9):1302-1307.
[6]闫海成.重型颅脑损伤600例临床分析[J].海南医学, 2013, 24(1):78-79.
[7] KOWALSKI RG, HAARBAUER-KRUPA JK, BELL JM, et al. Acute ischemic stroke after moderate to severe traumatic brain injury:incidence and impact on outcome[J]. Stroke, 2017, 48(7):1802-1809.
[8]刘睿,于东.重型颅脑损伤预后相关因素分析及营养支持治疗时机对术后感染的预防效果[J].重庆医学, 2014, 43(36):4945-4947.
[9]薛洪利,张国华,于春泳,等.香丹注射液治疗急性重型颅脑损伤的内皮素含量与临床疗效观察[J].国际神经病学神经外科学杂志,2009, 36(6):492-494.
[10]李娜,程晋成,王水平,等.重症监护病房颅脑损伤患者细胞因子检测的意义[J].中国实验诊断学, 2014, 18(1):28-31.
[11]王时龙,丁花艳. TNF、ET、CGRP在急性颅脑损伤患者血液及脑脊液中含量及意义[J].海南医学, 2013, 24(18):2759-2760.
[12]吴德模,管义祥,居兴云,等.蛛网膜下腔出血患者脑脊液中内皮素、氧合血红蛋白表达与脑血管痉挛相关性[J].贵阳医学院学报,2012, 37(6):629-631.
[13]涂艳阳,付建芳,付菊芳,等.不同剂量纳洛酮对重型颅脑损伤后β-内啡肽影响的实验研究[J].实用预防医学, 2011, 18(3):494-495.
[14]谭向红.纳洛酮联合神经节苷脂治疗急性大面积脑梗死40例疗效观察[J].海南医学, 2013, 24(15):2200-2201.
[15]李育平,张恒柱,佘磊,等.纳洛酮治疗急性重症颅脑损伤的Meta分析[J].中华神经外科疾病研究杂志, 2014, 13(3):204-208.
[2]陆弘盈,覃重桥,余松祚,等.亚低温治疗对重型颅脑损伤患者血浆内皮素的影响[J].微创医学, 2016, 11(4):509-512.
[3] HSU YY, JONG YJ, LIN YT, et al. Nanomolar naloxone attenuates neurotoxicity induced by oxidative stress and survival motor neuron protein deficiency[J]. Neurotox Res, 2013, 25(3):262-270.
[4]李莉.肢体功能训练对颅脑损伤患者肢体功能、神经功能和日常生活能力的影响[J].西部中医药, 2014, 27(12):124-125.
[5]余国亮.尼莫地平对高血压脑出血急性期患者神经功能缺损程度评分、脑血流动力学参数及临床疗效的影响[J].中国基层医药,2017, 24(9):1302-1307.
[6]闫海成.重型颅脑损伤600例临床分析[J].海南医学, 2013, 24(1):78-79.
[7] KOWALSKI RG, HAARBAUER-KRUPA JK, BELL JM, et al. Acute ischemic stroke after moderate to severe traumatic brain injury:incidence and impact on outcome[J]. Stroke, 2017, 48(7):1802-1809.
[8]刘睿,于东.重型颅脑损伤预后相关因素分析及营养支持治疗时机对术后感染的预防效果[J].重庆医学, 2014, 43(36):4945-4947.
[9]薛洪利,张国华,于春泳,等.香丹注射液治疗急性重型颅脑损伤的内皮素含量与临床疗效观察[J].国际神经病学神经外科学杂志,2009, 36(6):492-494.
[10]李娜,程晋成,王水平,等.重症监护病房颅脑损伤患者细胞因子检测的意义[J].中国实验诊断学, 2014, 18(1):28-31.
[11]王时龙,丁花艳. TNF、ET、CGRP在急性颅脑损伤患者血液及脑脊液中含量及意义[J].海南医学, 2013, 24(18):2759-2760.
[12]吴德模,管义祥,居兴云,等.蛛网膜下腔出血患者脑脊液中内皮素、氧合血红蛋白表达与脑血管痉挛相关性[J].贵阳医学院学报,2012, 37(6):629-631.
[13]涂艳阳,付建芳,付菊芳,等.不同剂量纳洛酮对重型颅脑损伤后β-内啡肽影响的实验研究[J].实用预防医学, 2011, 18(3):494-495.
[14]谭向红.纳洛酮联合神经节苷脂治疗急性大面积脑梗死40例疗效观察[J].海南医学, 2013, 24(15):2200-2201.
[15]李育平,张恒柱,佘磊,等.纳洛酮治疗急性重症颅脑损伤的Meta分析[J].中华神经外科疾病研究杂志, 2014, 13(3):204-208.