早期应用尼莫地平联合腰大池引流治疗重型颅脑损伤的临床分析

摘要

Objective To explore the clinical value of early application of nimodipine combined with lumbar cistern drainage in the treatment of severe traumatic brain injury .Methods a total of 68 cases elderly patients with severe craniocerebral injury in our hospital from 2015 to 2017 were selected ,which were divided into control group and observation group according to random number table method .The control group was given routine medical treatment ,and the observation group was given nimodipine combined with lumbar cistern drainage on the basis of the control group .The Glasgow Coma Scale (GCS) score ,cerebral CT and blood flow velocity measurement of middle cerebral artery (MCA) were was performed ,and the recovery and prognosis were compared in the two groups .Results The GOS score and MCA blood flow velocity of the observation group at 7 ,14 and 21d after treatment were significantly higher than those in the control group(P＜0 .05);the decline rate of intracranial pressure in the observation group at 7 ,10 and 14d after treatment was significantly higher than that in the control group (P＜0 .05);the probability of infection in the observation group was significantly lower than that in the control group (P＜0 .05);the prognosis rate of the observation group was significantly better than that of the control group(P＜0 .01) .Conclusion Early use of nimodipine combined with lumbar continuous drainage in the treatment of severe traumatic brain injury can effectively improve the clearance rate of subarachnoid hemorrhage ,re-duce the occurrence of secondary brain injury ,avoid cerebral vasospasm ,and improve the prognosis of patients.%目的 探讨早期应用尼莫地平联合腰大池引流治疗重型颅脑损伤的临床价值.方法 选取2015-2017年该院重型颅脑损伤老年患者68例,根据随机数字表法将其分为对照组与观察组,对照组给予常规内科治疗,观察组在对照组基础上给予尼莫地平联合腰大池引流,进行格拉斯哥昏迷量表(GCS)评分和颅脑CT、大脑中动脉(MCA)血流速度检测,比较两组恢复情况与预后情况.结果 观察组治疗后7、14、21 d时GCS评分与MCA血流速度明显高于对照组(P<0.05),观察组治疗后7、10、14 d时观察组颅内压下降速度明显高于对照组(P<0.05),观察组发生感染的概率明显低于对照组(P<0.05),观察组预后总良好率明显优于对照组(P<0.01).结论 早期对重型颅脑损伤患者使用尼莫地平联合腰大池持续引流进行治疗,能有效提高患者蛛网膜下腔出血的清除速度,减少继发性脑损伤的发生,避免脑血管痉挛,提高患者的预后.