出诊现场联合应用小剂量甘露醇与纳络酮对高血压性脑出血GCS评分及呼吸影响的临床研究

目的:探讨出诊现场联合应用小剂量甘露醇与纳络酮治疗对高血压性脑出血患者格拉斯哥(GCS)昏迷评分及呼吸变化的影响。方法:将出诊现场诊断为高血压急性脑出血伴昏迷、呕吐但自主呼吸正常的患者,随机分为应用小剂量甘露醇(对照组182例)治疗和联合小剂量纳络酮(研究组181例)治疗,观察2组患者GCS评分及呼吸变化。结果:2组患者出诊现场脑功能GCS评分均较低,表明脑功能受损严重,治疗后对照组的GCS评分有所上升,但与治疗前比较,无显著性差异(P>0.05);而研究组治疗后的GCS评分(6.85±1.16)显著高于对照组(5.99±1.41),表明研究组脑功能的改善优于对照组,差异有统计学意义(P<0.01)。自主呼吸变化方面,治疗后研究组患者的自主呼吸显著优于对照组,其自急救现场至回到急诊科60min内发生呼吸停止的患者仅为4.97%,显著少于对照组的18.86%(P<0.05)。结论:出诊现场联合应用小剂量甘露醇与纳络酮有利于高血压性脑出血患者脑功能的改善和自主呼吸的维持。

Effects of Small Doses of Mannitol Combined with Naloxone for Hypertensive Cerebral Hemorrhage in the Emergency Scene on GCS Score and Respiratory Site Visits

OBJECTIVE：To discuss the effect of small dose of mannitol combined with naloxone for hypertensive cerebral hemorrhage in the emergency scene on Glasgow coma score （GCS） and respiratory.METHODS：Patients diagnosed hypertensive cerebral hemorrhage with coma and vomiting but normal spontaneous breathing in the emergency scene were randomly given small dose of mannitol （control group, n=182） and small dose of mannitol combined with naloxone （study group, n=181）.GCS score and respiratory changes of 2 groups were observed.RESULTS：Patients of 2 groups in the emergency scene showed low GCS score of brain function, which indicated severe impairment of brain function.After treatment GCS score of control group increased.But there was no significant difference before and after treatment （P0.05）.After treatment GCS score of study group （6.85±1.16） was significantly higher than that of control group （5.99±1.41）, which indicated the improvement of brain function in study group was better than in control group.There was statistical significance （P0.01）.After treatment, spontaneous respiration of study group was significantly better than that of control group.Respiratory arrest occurred in 4.97% of patients when they were send to emergency department from emergency scene within 60 min, which was significantly less than control group of 18.86% （P0.05）.CONCLUSION：Small doses of mannitol combined with naloxone contribute to improve brain function of patients with hypertensive cerebral hemorrhage and to maintain spontaneous respiration.