摘要
目的 探讨金尔伦 (盐酸纳洛酮 )在急性重型颅脑外伤中的运用效果及其机制。方法 146名急性重型颅脑损伤病人随机分成金尔伦治疗组 (n =75 )和对照组 (n =71) ,观察治疗早期病人生命体征、颅内压、头颅CT变化和远期疗效 ,以及治疗前后血、脑脊液中 β 内啡肽变化情况。结果 金尔伦治疗组早期病人呼吸循环较快恢复稳定 ,呼吸异常 (2 9 3% )、心律异常 (30 7% )及伤后 1周颅内压显著升高 (2 0 % )和重度脑水肿者 (2 0 % )均较对照组明显减少 (P <0 0 1) ;金尔伦组1周后意识转清醒率 (5 4 7% )及伤后 3个月恢复良好率 (42 7% )显著高于对照组 (P <0 0 5 ) ,重残及死亡率 (37 3% )明显减少 (P <0 0 5 )。金尔伦组病人 β 内啡肽下降程度及速度较对照组显著加快 (P <0 0 1)。结论 金尔伦可以降低急性重型颅脑外伤病人颅内压的升高幅度 ,缩短昏迷时间 ,降低伤残率 ,促进病人神经功能恢复 ,改善预后 ,其机制可能是拮抗并抑制伤后 β 内啡肽的释放。
Objective To discuss the clinical effects and mechanism of Naloxone (NLX) for acute severe brain injuries. Methods A total of 146 patients with acute severe traumatic head injury were divided into two groups randomized(75 cases were treated with NLX and 71 cases were control). The clinical data, neurological outcome after treatment and β endorphin(β EP) in blood and cerebral spinal fluid(CSF) peritreatment were observed. Results The fluctuation of vital signs in the first 3 days was smoother in NLX group than that in control, including arrhythmia(P<0 01) and abnormal respiration (P<0 01). CT scanning and lumbar puncture showed that the severity of brain edema and increase of intracranial pressure was less remarkable (P<0 01) after treatment of NLX for one week. More patients revived in NLX group than that in control (P<0 05) in 7 days accompanied by higher recovery rate (P<0 05) and lower disability (P<0 05) after three months. The β EP was more rapidly decreased in NLX than that in control(P<0 01). Conclusions A successive early large dosage of NLX can relieve traumatic brain edema and improve the recovery of coma and reduce the disability in acute severe brain injuries. The mechanism maybe naloxone can resist the release of β EP posttraumatically.
出处
《中华神经外科杂志》
CSCD
北大核心
2001年第3期149-151,共3页
Chinese Journal of Neurosurgery
