盐酸纳洛酮对急性脑损伤患者催醒作用的临床研究

【目的】探讨盐酸纳洛酮对急性脑损伤昏迷患者的催醒作用效果及其机制。【方法】严格选择 12 0例急性脑损伤患者 ,随机分为治疗组与对照组 ,各 6 0例 ,其中各组又按GCS评分随机分为中、重度两组。在常规治疗的基础上 ,治疗组给以盐酸纳洛酮 4mg/d ,连续使用 2周。治疗期间观察各组患者GCS变化以及 2周后患者的意识恢复情况 ,并行统计学处理。【结果】治疗期间中、重度脑损伤治疗组与对照组之间GCS评分的明显差异 (P <0 .0 5 )出现在用药后d5,并持续至治疗结束。 2周后治疗组与对照组比较意识好转情况有明显的差异 (P <0 .0 5 )。【结论】早期、大剂量应用盐酸纳洛酮治疗急性脑损伤能有效的阻断原发性脑损伤后的继发性脑损害 ,促进神经功能恢复 ,缩短昏迷时间 ,具有明显的催醒作用 ,并且无明显的毒副作用。

Clinical Study on the Awakening Effect of Naloxone Chloride for Treatment of Coma in Patients with Acute Brain Injuries

Objectives]To investigate the clinical effects and mechanism of naloxone chloride (NC) for awakening of coma in patients with acute brain injuries (ABI).One hundred and twenty patients with ABI were divided into two groups: 60 patients were treated on routine schedule (control group) and other 60 patients were treated with 4mg/d of NC for 2 wks on the basis of routine therapy (treated group). Each group was redivided into moderate and severe subgroups according to the Glasgow coma scale (GCS) and consciousness during treatment. The changes of GCS and recovery of consciousness after 2 wks in the course of therapy were observed and compared statistically.During treatment, a significant difference between the GCS scores of treated group with moderate / severe ABI and those of control group appeared at 5th day after drug administration and was maintained until termination of treatment (P<0.05). Two weeks later the awakening and recovery of consciousness in treated group were much better than those in controls (P<0.05). Conclusion] Application of large dose NC in early stage of ABI can effectively hinder the secondary brain damage occurring after primary injury due to production of endogenous opioid peptides in stress , improve the recovery of brain function and shorten the duration of coma. Moreover, no toxic adverse effect was found.