应用脑电图绝对功率值变化评估不同剂量纳洛酮干预颅脑损伤患者的效应

背景纳洛酮在脑损伤后急性期应用可以维持脑灌注压、减轻脑水肿,在一定程度上阻止脑损伤后的继发性脑损害,但在临床应用中各家报道的剂量和用法差异较大.目的观察不同剂量纳洛酮对急性脑损伤患者脑电图绝对功率值的影响.了解不同剂量的纳洛酮的脑保护作用特点.设计以患者为研究对象,病例-对照实验.单位一所大学医院的神经外科.对象2002-01/2003-04收入重庆医科大学附属第一医院神经科重症监护病房的急性中、重型闭合性脑损伤患者86例,男59例,女27例,年龄18～65岁.方法急性脑损伤患者86例按伤情轻重分为格拉斯哥昏迷量表评分3～5分、6～8分、9～12组.每组再分为纳洛酮治疗组和对照组.纳洛酮治疗组又分为小剂量组及大剂量组.用定量脑电图监测,用药前、用药后30min,1,2,24,48,72,120 h脑电图总功率值的变化.主要观察指标各组患者用药前后脑电图总绝对功率值的变化.结果格拉斯哥昏迷量表9～12分纳洛酮治疗组用药1h后总功率值与对照组比较,差异有显著性意义(P＜0.05),大小剂量间无差异;格拉斯哥昏迷量表6～8分,大小剂量组用药1h后总功率值与对照组比较,差异均有显著性意义(P＜0.01),且大剂量组高于小剂量组.格拉斯哥昏迷量表3～5分,纳洛酮治疗组与对照组之间总功率值差异无显著性意义.结论对中型脑伤,小剂量的纳洛酮治疗有足够的疗效;对重型脑伤,大剂量治疗优于小剂量;对特重型脑伤,大小剂量均无效.

The fluctuation of absolute power values of electroencephalogram for evaluating the efficacy of different dose of naloxone in brain injury

BACKGROUND: Applying naloxone in acute brain injury can sustain the cerebral perfusion pressure(CPP), alleviate the cerebral edema and prevent the secondary brain damage to a certain degree. But the dosage and the administration of naloxone in clinical practices vary substantially according to the literatures.OBJECTIVE: To investigate the effect of different doses of naloxone on the changes in the absolute power values of electroencephalography(EEG) in acute brain injury, and study the protective effects of naloxone at different doses.DESIGN: Case-control study based on patients.SETTING: Neurosugery department of a hospital affiliated to a university PARTICIPANTS: From January 2002 to April 2003, at the Intensive Care Unit(ICU) of theNeurosugery Department of the First Hospital Affiliated to the Chongqin Medical University, 86 patients with moderate or severe acute closed brain injury were selected. Of all the patients, 59 were male and 27 were female, aged between 18 - 65.METHODS: According to the degree of injury graded by Glasgow Coma Scale(GCS), the 86 patients bearing acute brain injury were divided into 3 groups: GCS 3 - 5 group, GCS 6 - 8 group and GCS 9 - 12 group. Each group contained a naloxone treatment group and a matched control group. The naloxone treatment group consisted of a low-dose naloxone subgroup and a large-dose naloxone subgroup. The changes in the total power value of EEG before treatment and at the time of 30 minutes, 1, 2, 24, 48, 72 and 120 hours after treatment were measured respectively using quantitative EEG monitor.MAIN OUTCOME MEASURES: The changes in the total power value of the patients' EEG before and after treatment were observed and recorded.RESULTS: The difference between the total power of EEG of the GCS 9 - 12naloxone treatment group 1 hour after a naloxone treatment and that of the matched control group was statistically significant(P ＜ 0.05); The same comparison between the low-dose and the large-dose naloxone subgroups within the GCS 9 - 12 naloxone treatment group yielded no significant difference. In the GCS 6 - 8 naloxone treatment group, the difference between the total power of EEG 1 hour after a naloxone treatment and that of the matched control group was statistically significant, and the large dose subgroup was more significant than the low-dose group. In the GCS 3 - 5 naloxone treatment group, no significant difference between the total power of EEG of the naloxone group and that of the control group could be observed.CONCLUSION: The low-dose naloxone treatment is helpful enough on the intervention for moderate brain injury, and the large-dose naloxone treatment is better than the low-dose on severe brain injury. For the patients with exceptionally severe brain injury, both the two treatments are proved to have no therapeutic effects.