奥拉西坦联合尼莫地平治疗重症脑挫裂伤的临床观察

目的观察奥拉西坦联合尼莫地平治疗重症脑挫裂伤的临床疗效。方法选取新疆医科大学第二附属医院2010年11月—2014年10月收治的重症颅脑损伤患者130例,随机分为对照组(68例)和治疗组(62例)。两组患者术后均转入ICU监护并给予等常规治疗,对照组给予尼莫地平注射液4 mg/次,加入到250 m L生理盐水中静脉滴注,1次/d。治疗组在对照组基础上加用注射用奥拉西坦,4 g/次,加入到250 m L生理盐水中缓慢静滴,1次/d。两组均连续治疗14 d。比较两组的临床疗效,同时比较两组治疗前,治疗第3、7、14天神经功能缺损(NIHSS)评分、颅内压、GCS评分、脑电图快慢波比值、大脑中动脉(Mc A)平均血流速度、双侧平均肌力的变化。结果对照组和治疗组总有效率分别为61.76%、80.65%,两组比较差异有统计学意义(P0.05)。对照组NIHSS评分从治疗第7天,治疗组从治疗第3天开始显著下降,同组比较差异有统计学意义(P0.01)。从治疗第3天开始治疗组NIHSS评分显著低于对照组,两组比较差异有统计学意义(P0.05、0.01)。两组颅内压均从治疗第3天开始降低,GCS评分、Mc A平均血流速度、双侧平均肌力从治疗第3天开始升高,同组治疗前后差异有统计学意义(P0.01)。治疗组从治疗第3天开始,GCS评分、Mc A平均血流速度高于对照组,治疗组在治疗第3、7天颅内压低于对照组,在治疗第7天快慢波比值低于对照组,在治疗第3、14天双侧平均肌力高于对照组,两组比较差异有统计学意义(P0.05、0.01)。结论奥拉西坦联和尼莫地平治疗重症脑挫裂伤术后患者具有较好的临床疗效,可促进患者神经功能恢复,提高患者生存质量,为进一步探索和治疗重症脑挫裂伤患者提供明确的思路。

Clinical observation of oxiracetam combined with nimodipine in treatment of severe cerebral contusion

Objective To explore the clinical effect of oxiracetam combined with nimodipine in treatment of severe cerebral contusion. Methods The patients with severe cerebral contusion (130 cases) of the Second Affiliated Hospital of Xinjiang Medical University from November 2010 to October 2014 were randomly divided into control (n=68) and treatment (n=62) groups. The patients in two groups were transferred to the ICU after the surgical treatment and given conventional treatment. The patients in the control group were iv administered with Nimodipine Injection 4 mg/time, which was diluted with 250 mL physiological saline once daily. The patients in the treatment group were iv administered with Oxiracetam for injection (4 g diluted with 250 mL physiological saline) on the basis of control group, once daily. The patients in two groups were treated for 14 d. After the treatment, the efficacy was evaluated, and NIHSS score, intracranial pressure, GCS score, electroencephalogram wave ratio, average blood flow velocity of middle cerebral artery (McA), and the average strength on both sides before and 3, 7, 14 d after the treatment in two groups were compared. Results The efficacies in the control and treatment groups were 61.76% and 80.65%, respectively, and there were differences between the two groups (P< 0.05). After treatment, the NIHSS score in the control group significantly reduced from the seventh day of treatment, while from the third day of treatment in the treatment group, and the difference was statistically significant in the same group (P< 0.01). NIHSS score of the treatment group was lower than that in the control group from the third day of treatment, with significant difference between two groups (P< 0.05, 0.01). Intracranial pressure in two groups was statistically reduced from the third day of treatment, and GCS score, average blood flow velocity of McA, and average strength on both sides were increased from the third day of treatment, and the difference was statistically significant in the same group (P< 0.01). GCS score, and average blood flow velocity of McA in the treatment group were higher than those in the control group from the third day of treatment, and intracranial pressure of treatment group was lower than that in the control group on the third and seventh day of treatment. Electroencephalogram wave ratio in the treatment group was lower than that in the control group on the seventh day of treatment, and the average strength on both sides in the treatment group was higher than that in the control group on the third and 14th day of treatment, with significant difference between two groups (P< 0.05, 0.01). Conclusion Oxiracetam combined with nimodipine has the good clinical effect in treatment of severe cerebral contusion, and can promote the neurologic recovery, while can improve the quality of survival, which offers a clear train of thought for further treatment of patients with severe cerebral contusion.