亚低温联合大剂量纳洛酮治疗外伤性急性弥漫性脑肿胀的临床研究

目的探讨亚低温联合大剂量纳洛酮治疗外伤性急性弥漫性脑肿胀(PADBS)的机制与疗效。方法选择伤后12 h内入院的PADBS患者51例(治疗组)接受亚低温联合大剂量纳洛酮治疗,同期入院常温下未用纳洛酮治疗的同类患者51例作为对照组;所有患者其他治疗措施均基本相同。同时监测病人的生命体征,血浆β-内啡肽(β-EP)均值、颅内压(ICP)、脑灌注压(CPP)、血糖、血乳酸、血气、血电解质。均于伤后3个月时根据GOS评估法判定疗效。结果与对照组相比,亚低温联合大剂量纳洛酮治疗组病人伤后早期的血浆β-EP均值、高ICP、高血糖、高乳酸血症分别明显下降(P<0.01),低CPP明显上升(P<0.01);生命体征、血气及血电解质差异无统计学意义;无严重并发症。将恢复良好、中残、重残合称为治疗有效,将植物生存、死亡合称为治疗无效。治疗组治疗有效率显著高于对照组(P<0.05),而治疗无效率显著低于对照组(P<0.05)。治疗组觉醒天数显著短于对照组(P<0.01)。结论PADBS患者早期应用亚低温联合大剂量纳洛酮治疗可明显提高临床疗效,缩短昏迷时间,无严重并发症。

Clinical Study of Treatment with Mild Hypothermia and High Dose Naloxone for Post-traumatic Acute Diffuse Brain Swelling

Objective To study the therapeutic mechanism and the effect of mild hypothermia and high dose naloxone on the patients with post-traumatic acute diffuse brain swelling(PADBS).Methods A total of 102 patients with PADBS Glasgow coma scale(GOS) score ≤ 8 on admission] were randomly divided into trial group(n=51) and control group(n=51).The trial group was treated with mild hypothermia plus high dose naloxone and the control group treated under the condition of normal temperature without naloxone.Meantime,the parameters,such as vital signs,blood β-endorphin(β-EP),intracranial pressure(ICP),cranial perfusion pressure(CPP),blood glucose,blood lactate,blood gas values,blood electrolytes,were measured.According to GOS scoring,the prognosis of the patients was evaluated.Results In comparison with control group,increased blood β-EP,ICP,and blood glucose and lactate decreased significantly(P<0.01),and decreased CPP significantly increased(P<0.01).In the trial group,21 cases were treated effectively and 30 cases treated without effect,while in the control group,the counterparts were 11 and 40,respectively.There were significant differences between the two groups(P<0.05).The time of awakening or consciousness recovery was shortener in the trial group than in the control group(P<0.01).Conclusion The condition of the patients with PADBS can be improved by administration of mild hypothermia and high dose naloxone.