头部局部亚低温联合纳美芬治疗对重型颅脑损伤患者神经功能及脑血流动力学的影响

摘要

Objective:To investigate the effect of local mild hypothermia combined with nalmefene hydrochloride on neural function and cerebral hemodynamics in patients with severe traumatic brain injury (STBI).Methods:From February 2014 to February 2016,84 patients with STBI in our hospital were selected and randomly divided into a control group and an observation group,with 42 cases in each group.The patients in the control group received conventional therapy,and those in the observation group were treated as the control group with addition of nalmefene hydrochloride.Intracranial pressure (ICP) and Glasgow coma scale (GCS) score were observed and compared.S100 protein and glial fibrillary acid protein (GFAP) levels were detected by enzyme linked immunosorbent assay (ELISA).Peak blood flow velocity (Vs),mean blood flow velocity (Vm) and pulsatility index (PI) in bilateral middle cerebral artery as well as the complications were recorded.Results:There were no significant differences in ICP and GCS score between the two groups before treatment (P＞0.05).However,the ICP in the observation group was significantly lower than that in the control group after 7 and 14 days of treatment,and the GCS score was higher (P＜ 0.05).No significant differences were found in Vs,Vm and PI as well as the serum levels of S100β and GFAP between the two groups on posttreatment day 1 (P＞0.05).After 7 and 14 days of treatment,the levels of S100β and GFAP in serum and PI were decreased,while the Vs and Vm were increased in the observation group,compared with the control group (P＜＜0.05).There was no significant difference in the incidence of complications between the two groups (P＞0.05).Conclusion:Local mild hypothermia combined with nalmefene hydrochloride could effectively reduce ICP,improve cerebral hemodynamics and promote neural function recovery in patients with STBI.%目的:研究头部局部亚低温联合纳美芬对重型颅脑损伤(STBI)患者的脑保护作用.方法:选取2014年2月至2016年2月广西医科大学第二附属医院收治的84例STBI患者,随机分为对照组与观察组,每组42例.对照组给予常规治疗,观察组在对照组治疗的基础上给予头部局部亚低温联合纳美芬治疗,比较两组治疗前及治疗后第1、第7、第14天的颅内压(ICP)、格拉斯哥昏迷评分(GCS).采用酶联免疫吸附试验(ELISA)法检测两组治疗后第1、第7、第14天的神经功能指标S100β蛋白、胶质纤维酸性蛋白(GFAP)水平.记录两组患者治疗后双侧大脑中动脉收缩期峰值血流速度(Vs)、平均血流速度(Vm)、搏动指数(PI)及治疗期间并发症的发生情况.结果:两组治疗前ICP和GCS评分比较,差异无统计学意义(P＞0.05);治疗后第7、第14天,观察组ICP明显低于对照组,GCS评分高于对照组(P＜0.05).治疗后第1天,两组Vs、Vm、PI及血清S100β、GFAP水平比较,差异均无统计学意义(均P＞0.05);但在治疗后第7、第14天,观察组血清S100β、GFAP水平及PI均明显低于对照组,Vs、Vm高于对照组,差异均有统计学意义(均P＜0.05).两组并发症发生率比较差异无统计学意义(P＞0.05).结论:头部局部亚低温联合纳美芬能有效降低STBI患者的ICP,改善脑血流动力学指标,促进神经功能恢复,值得临床推广应用.