亚低温联合大剂量纳洛酮治疗脑出血的疗效观察

目的探讨亚低温、纳络酮以及两者联合治疗脑出血的疗效及安全性。方法40例急性脑出血患者随机分为4组：对照组10例，发病后给予甘露醇脱水、6一氨基已酸止血等常规治疗；亚低温组10例，在常规治疗的基础上给予亚低温治疗4d，鼻咽温度控制在33—34℃；纳络酮组10例，在常规治疗的基础上给予4mg纳络酮静脉点滴，每日1次，共14d；联合组10例，在常规治疗的基础上给予头颅亚低温治疗和静脉点滴纳络酮。于入院时和治疗第14d行头颅cT扫描，测定出血量和水肿量；并于治疗前、后用欧洲卒中评分量表（ESS）评定患者神经功能。结果治疗前：4组间比较，出血量、水肿量和ESS评分差异均无统计学意义（P〉0．05）。治疗第14d，4组间出血量差异无统计学意义（P〉0．05）；亚低温组水肿量与联合组接近（P〉o．05），但明显低于纳络酮组（P〈0．05）和对照组（P〈0．05），纳络酮组明显低于对照组（P〈0．05）。治疗后ESS评分由高到低分别是：联合组、亚低温组、纳络酮组；各组间的分值比较，差并均有统计学意义（P〈0.05）。结论头颅亚低温和纳络酮静脉点滴治疗均能明显减轻脑出血患者的脑水肿，改善其神经功能缺损；亚低温在减轻脑水肿和改善神经功能缺损方面的作用均优于纳络酮；联合应用虽不能进一步减轻脑水肿，但对神经功能缺损的改善作用更明显。

Observation of the Curative Effect of Mild Hypothermia Combined with High Dosage of Naloxone on Intracerebral Hemorrhage

Objective To discuss the curative effect and the safety of mild hypothermia,naloxone and the combination of the 2 in the treat- ment of intracerebral hemorrhage. Methods 40 cases were randomly divided into 4 groups： control group, mild hypothermia group, naloxone and the combined group, 10 in each; routine treatment with mannitol for dehydration and 6 - aminocaproic acid for hemostasis was performed to all the eases in the 4 groups while mild hypothermia was added to the 10 in mild hypothermia group with the nasopharyngeal temperature about 33 to 34℃,intravenous drip of4mg naloxone,once a day for 14 days was added to the 10 cases in naloxone group and mild hypother- mia of the head plus the intravenous drip of naloxone was added to the combined goup：all the patients received cranial CT scanning at ad- mission and on the 14th day of the treatment to measure out the volume of hemorrhage and edema; European Stroke Standards （ESS） was applied before and after treatment to evaluate the neurological function of the patients. Results There existed no statistical differences in the volume of hemorrhage and edema and European Stroke Standards （ESS） scores among the 4 groups （P 〉 0. 05） ; on the 14th day of treat- ment, the volumes of hemorrhage were of no statistical difference （ P 〉 0. 05） ; the volume of edema of the patients in mild hypothermia group was almost the same with that in combined group （ P 〉 0. 05 ） and was much lower than that in naloxone group （ P 〈 0. 05 ） ; the vol- ume of edema of the patients in naloxone group was obviously lower than that in control group （P 〈0. 05） ; the European Stroke Standards （ESS） scores of each group after treatment ranges from high to low as follows： combined group, mild hypothermia group and naloxone group,the score volumes in the 4 groups were of statistical significance （P 〈 O. 05）. Conclusions Both mild hypothermia and intravenous drip of naloxone can reduce the intracerebral edema of the patients with cerebral hemorrhage and improve the neurological impairment but the effect of mild hypothermia is superior to that of naloxone; the combined treatment is of more obvious effect in improving neurological impairment.