盐酸纳美芬对急性创伤性颅脑损伤疗效及脑保护作用观察

目的 探讨盐酸纳美芬治疗急性创伤性颅脑损伤的临床效果,并分析其脑保护作用.方法 选取解放军252医院于2013年1月-2016年5月收治的92例急性创伤性颅脑损伤患者作为研究对象,按照治疗方法将其分成两组,每组46例.两组均给予常规治疗,观察组在此基础上给予盐酸纳美芬治疗,比较两组近期疗效、预后以及治疗前、治疗第1、3、7和14天血清β-内咖肽、S100B蛋白、神经特异性烯醇化酶(NSE)水平.结果 观察组治疗第1、3、7和14天血清β-内咖肽、S100B蛋白、NSE水平逐渐下降,且明显低于治疗前(P＜0.01);对照组治疗第7和14天血清β-内咖肽水平逐渐下降,明显低于治疗前(P＜0.01),治疗第3、7和14天血清S100B蛋白、NSE水平逐渐下降,均明显低于治疗前(P＜0.01);观察组治疗后同时间点血清β-内咖肽、S100B蛋白、NSE水平均明显低于对照组(P＜0.01).观察组呼吸异常和心率异常发生率均明显低于对照组(P＜0.05),颅内压控制效果明显优于对照组(P＜0.05),预后良好率明显高于对照组(P＜0.05).两组不良反应发生率比较差异无统计学意义(P＞0.05).结论 在常规治疗基础上联合使用盐酸纳美芬治疗急性创伤性颅脑损伤可有效提高临床效果,减轻继发性脑损害,脑保护作用明显.

Effect of Nalmefene Hydrochloride on Curative Effect and Protective Effect for Brain in Patients with Acute Traumatic Brain Injury

Objective To investigate clinical effect of Nalmefene Hydrochloride in treatment of patients with acute traumatic brain injury and to analyze its protective effect for brain.Methods A total of 92 patient with acute traumatic brain injury admitted during January 2013 and May 2016 were divided into two groups according to different treatment methods (n =46 for each group).All patients received routine treatment,and objective group was added Nalmefene Hydrochloride.Short-term effect,prognosis,levels of serum β-endorphin,S100B protein and neuron-specific enolase (NSE) before and at 1st,3rd,7th and 14th days after treatment were compared in two groups.Results In observation group,levels of serum β-endorphin,S100B protein and NSE before and at 1 st,3rd,7th and 14th days after treatment were decreased gradually,and the levels were significantly lower than those before treatment (P ＜ 0.01).In control group,serum β-endorphin levels 7th and 14th days after treatment were increased gradually,and the levels were significantly lower than that before treatment (P ＜ 0.01);S100B protein and NSE levels 3rd,7th and 14th days after treatment were decreased gradually,and the levels were significantly lower than those before treatment (P ＜ 0.01).Levels of serum β-endorphin,S100B protein and NSE in observation group were significantly lower than those in control group at the same time after treatment (P ＜ 0.01).In observation group,incidence rates of abnormal breathing and heart rate were significantly lower than those in control group (P ＜ 0.05),while effect for controlling intracranial pressure was significantly better than that in control group (P ＜ 0.05),and good prognosis rate was significantly higher than that in control group (P ＞0.05).Conclusion Combined use of Nalmefene Hydrochloride in treatment of acute traumatic brain injury on the basis of routine treatment can effectively improve curative effect and reduce the secondary brain damage with obviously protective effect for brain.