目的 探讨重组人促红细胞生成素联合纳洛酮用于治疗重型颅脑损伤昏迷患者的临床效果.方法 选取2013年3月至2014年5月于北京朝阳急诊抢救中心接受治疗的重型颅脑损伤昏迷患者80例,格拉斯哥昏迷量表(GCS)评分3～8分,将患者完全随机分为观察组和对照组,各40例.2组患者均给予生命监护、止血、激素以及局部亚低温等常规治疗,对照组静脉/肌内注射纳洛酮(0.01 ～0.02 mg/kg,若给药后无反应,3 ～5 min后重复1次,直至患者苏醒),后续给予纳洛酮2 mg加入5％葡萄糖或0.9％氯化钠注射液中持续静脉滴注,给药时间为45～90 min;观察组在对照组基础上于治疗第1、4、7、10、13天皮下注射重组人促红细胞生成素7 500 IU/次,持续2周.比较2组患者治疗前后GCS评分、转为清醒的时间、治疗有效率、白细胞介素(IL)-10、高敏C反应蛋白(hs-CRP)及脑梗死面积.结果 治疗后观察组患者GCS评分明显高于对照组和治疗前[(12.8±7.9)分比(9.7±5.5)、(5.2±2.6)分],差异有统计学意义(均P＜0.05).观察组患者转为清醒的时间明显短于对照组[(3.1±1.4)d比(5.2±2.3)d],差异有统计学意义(P＜0.05).观察组患者的临床有效率明显高于对照组[70.0％ (28/40)比60.0％ (24/40)],差异有统计学意义(P＜0.05).治疗后,观察组IL-10高于对照组[(5.6±1.2) mmol/L比(2.7 ±0.5) mmol/L],hs-CRP低于对照组[(1.3±0.5) mg/L比(3.9±1.5) mg/L],梗死面积小于对照组[(1.9±0.3)cm2比(2.7±0.8) cm2],差异有统计学意义(均P＜0.05).结论 重组人促红细胞生成素联合纳洛酮治疗与单纯应用纳洛酮比较可进一步改善重型颅脑损伤昏迷患者的临床效果及预后.%Objective To study the clinical effect of recombinant human erythropoietin combined with naloxone on coma patients post severe craniocerebral trauma.Methods A total of 80 consecutive comas patients of severe craniocerebral trauma with Glasgow coma scale (GCS) score of 3-8 in Beijing Chaoyang Emergency Medical Center from March 2013 to May 2014 were enrolled and randomly divided into observation group (40 cases) and control group (40 cases).Conventional treatments including life care,bemostasia,lowering intracranial pressure and antiinfection were given in both groups.In addition,the patients in control group received intravenous injection of naloxone and the patients in observation group received erythropoietin (subcutaneous injection) combined with naloxone.The GCS score,waking-up time,effective rate,levels of inerleukin (IL)-10,high sensitivity C reactive protein (hs-CRP) and area of cerebral infarction were compared between the two groups before and after treatment.Results The GCS score in observation group after treatment was significantly increased compared with that before treatment [(12.8 ± 7.9) scores vs (5.2 ± 2.6) scores] ; it was also higher than that in control group [(9.7 ± 5.5) scores,P ＜ 0.05].The waking-up time in observation group was significantly less than that in control group [(3.1 ±1.4)d vs (5.2 ±2.3)d],and the total efficacy rate of observation group was significantly higher than that of control group [70.0％ (28/40) vs 60.0％ (24/40)] (both P ＜0.05).After treatment,in observation group,the IL-10 was higher,the hs-CRP was lower and the infarction area was smaller than those in control group [IL-10:(5.6 ± 1.2) mmol/L vs (2.7 ± 0.5) mmol/L,hs-CRP:(1.3 ± 0.5)mg/L vs (3.9 ±1.5)mg/L,infarction area:(1.9±0.3)cm2 vs (2.7 ±0.8)cm2](all P＜0.05).Conclusions Erythropoietin combined with naloxone can further improve clinical effect and prognosis of coma patients post severe craniocerebral trauma compared with single application of naloxone.
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