单唾液酸四己糖神经节苷脂对重型颅脑创伤后颅内压增高的治疗作用

目的探讨单唾液酸四己糖神经节苷脂(GM1)对重型颅脑创伤(sTBI)患者颅内压(ICP)增高和脑水肿的治疗作用。方法选取临床sTBI患者44例,随机分为对照组及观察组各22例,2组患者均予以气管切开、亚低温治疗、标准外伤开颅去大骨瓣手术治疗。对照组患者予以脱水、抗感染、纠正水电解质平衡、营养支持等常规治疗;观察组患者在对照组常规治疗的基础上加GM1钠盐注射液100 mg静脉滴注,每日1次,持续7 d。分别监测2组患者治疗前及治疗后2 h、4 h、6 h、8 h、3 d和7 d的ICP值;无创脑水肿监测仪分别监测2组患者治疗前和治疗后1 d、3 d、5 d和7 d脑水肿扰动系数;治疗7 d后复查头颅CT评价患者的脑水肿缓解状况并比较2组患者格拉斯哥昏迷评分(GCS)。结果观察组患者治疗4 h后ICP较对照组下降(P<0.05),治疗3 d后脑水肿扰动系数较对照组下降(P<0.05),治疗7 d后头颅CT提示脑水肿的缓解满意度大于对照组(P<0.05),GCS较对照组高(P<0.05)。结论GM1对于早期sTBI患者有一定的降颅压、缓解脑水肿的作用,可以改善患者昏迷程度。

Effect of monosialotetrahexosylganglioside on reducing the increased intracranial pressure in the patients with acute severe traumatic brain injury

Objective To study the effect of monosialotetrahexosylganglioside （GM1）on reducing the increased intracranial pressure （ICP） and alleviating the brain edema in the patients with acute severe traumatic brain injury （sTBI）. Methods 44 patients with sTBI were divided into observation group （n = 22） and control group （n = 22 ） randomly. Incision of trachea, mild hypothermia treatment and bone-flap remove surgery were done in the two groups. The conventional treatments such as ehydration, anti-infection drug, retrieving the balance of water electrolyte and nutrition supporting were done in the control group. Based on the conventional treatments,intravenous drip with GM1 saline injection 100 mg was added in observation group, once-daily for 7 days. The changes of ICP at 2 hours,4 hours,6 hours,8 hours,3 days and 7 days were monitored and the brain edema index at 1 day, 3 days, 5 days and 7 days were observed with noninvasive the cerebral edema monitor before and after treatment in the two groups. The state of the relief of brain edema was evaluated by brain CT scan at 7 days after treatment and the glasgow coma scores （GCS） in two groups were contrasted. Results The ICP at 4 hours after treatment and the brain edema index at 3 days after treatment in GM1 therapy group were lower than those in the control group （P 〈 0.05 ） ; At 7 days after treatment brain CT scan indicated that the degree of satisfaction of the relief of brain edema was higher than that in the control group（ P 〈 0.05 ） ;The GCS scores were higher than those in the control group （P 〈 0.05 ）. Conclusion GM1 can reduce the increased ICP and alleviate the brain edema at early stage of sTBI, and can improve the level of coma in the patients.