血必净预防重型颅脑外伤后MODS临床观察及护理注意事项

目的:探讨血必净预防重型颅脑外伤后多器官功能障碍综合征(MODS)临床效果及护理注意事项。方法:2012年7月—2013年12月收治的重型颅脑外伤患者60例作为研究对象,随机分组法将患者分为两组,对照组30例患者采用常规治疗法,研究组30例患者在常规治疗的基础上加用血必净。两组均加强护理关注,早发现早治疗。观察两组患者多器官损害情况,及患者内皮功能和血浆炎性指标、内毒素的变化情况。结果:入院1周时,观察组共8例患者发生MODS,因MODS死亡1例;对照组共16例患者发生MODS,因MODS死亡7例,观察组大大降低了MODS的发生和因MODS导致的死亡。入院时两组患者血浆内皮素、血管性血友病因子、血栓调节蛋白、肿瘤坏死因子-α和内毒素组间比较差异无统计学意义。伴随疾病的发展,两组患者血浆内皮素、血管性血友病因子、血栓调节蛋白、肿瘤坏死因子-α和内毒素均较入院前升高,其中观察组低于对照组(P<0.05)。结论:血必净可以降低重型脑外伤患者炎症因子及内毒素,并对患者内皮功能具有保护作用,因此,血必净对重型颅脑外伤后MODS的发生具有一定的预防价值。

Clinical Observation of Xuebijing Preventing MODS after Severe Traumatic Brain Injury and Its Nursing Considerations

Objective ：To investigate the clinical effect of Xuebijing on the prevention of MODS after severe traumatic brain injury and its nursing considerations. Methods ： Methods ： 60 cases of severe traumatic brain injury patients in July 2012 to December 2013 were treated as research subjects and were randomly divided into two groups. The control group＇s 30 patients were treated with conventional therapy and 30 patients in the observation group were treated with Xuebijing on the basis of conventional therapy. Both groups were given the enhanced care concern, early detection and early treatment. The multiple organ damage and the changes of endothelial function and plasma inflammatory markers as well as endotoxin changes were compared between the two groups. Results：Admission for one week, a total of 8 patients in the observation group occurred MODS and 1 patient died of MODS,both fewer than those of the control group（ 16 patients developed MODS and 7 patients died of MODS）. The plasma endothelin, von Willebrand factor, thrombomodulin, tumor necrosis factor - α and endotoxin in two groups of patients on admission did not had statistically significant difference. With the development of the disease, endothelin,von Willebrand factor, thrombomodulin,tumor necrosis factor- α and ndotoxin were all elevated than before and the observation groupg were lower than those of the control group （P 〈 0. 05 ）. Conclusion： Xuebijing can reduce inflammatory cytokines and endotoxin in patients with brain trauma and endothelial function in patients with a protective effect. Therefore, Xuebijing has a preventive value of MODS after severe traumatic brain injury.