摘要
目的观察机械通气联合丹参多酚酸治疗重症颅脑损伤患者临床疗效,及其对患者神经功能及结局的影响。方法选取2016年3月-2019年6月于邯钢医院治疗的重症颅脑损伤患者65例,按照随机数字表法分为对照组(n=33例)和观察组(n=32例)。所有患者均给予常规重型颅脑损伤治疗(例如脱水、激素、防感染及营养支持等)及对应的手术治疗。两组患者均在损伤后及手术后立即给予机械通气。观察组在对照组基础上给予丹参多酚酸盐。比较两组患者临床疗效;比较两组患者治疗前后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、神经功能重建相关因子[脑源性神经营养因子(brain-derived neurotrophic fac⁃tor,BDNF)及神经生长因子(nerve growth factor,NGF)水平]、凝血因子[纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)];比较两组患者预后情况。结果观察组的临床总有效率为93.75%,高于对照组的75.76%(χ^(2)=4.730,P=0.030)。治疗前,两组患者NIHSS评分、NGF、BDNF、PT、APTT、FIB、TT无差异(P≥0.05)。治疗后6个月,观察组NIHSS评分低于对照组(t=2.551,P=0.014)。治疗2周后,观察组NGF、BDNF及FIB水平高于对照组(t=12.048,P=0.000;t=8.389,P=0.000;t=6.574,P=0.000);TT水平低于对照组(t=2.891,P=0.000);两组患者PT、APTT水平无差异(P≥0.05)。两组患者轻度残疾率及死亡率无差异(P≥0.05);观察组的重度残疾率低于对照组(χ^(2)=4.920,P=0.027),恢复良好率高于对照组(χ^(2)=4.480,P=0.034)。结论机械通气联合丹参多酚酸盐治疗重症颅脑损伤具有良好的临床疗效,可以改善患者的神经功能,改善凝血功能,改善患者预后。
Objective To observe the clinical effects of mechanical ventilation combined with Salvia miltiorrhiza poly‐phenolic acid in the treatment of severe craniocerebral injury and its effect on nerve function and outcome.Methods Sixty-five patients with severe craniocerebral injury were randomLy divided into 2 groups:control group(n=33)treated with routine measures(e.g.dehydration,hormones,anti-infection and nutritional support,and),corresponding surgical procedures,and mechanical ventilation immediately after injury and operation,and observation group(n=32)given in‐travenous drip of Salvia miltiorrhiza polyphenolate 250 mg in 250 mL normal saline once a day for 2 weeks.On admis‐sion and 6 months after treatment.National Institute of Health stroke scale(NIHSS)was used to evaluate the neurologi‐cal function.Clinical efficacy was observed 6 months treatment.Before treatment and 2 weeks after treatment fasting peripheral blood samples were collected,the levels of brain-derived neurotrophic factor(BDNF)and nerve growth factor(GF)were tested by ELISA,and automatic blood coagulation analyzer.was used to test the levels of coagulation factors:fibrinogen(FIB),thrombin time(TT),prothrombin time(PT),and activated partial prothrombin time(APTT).Results The effective rate of the observation group was 93.75%,significantly higher than that of the control group(75.76%,χ^(2)=4.730,P=0.030).Before treatment,there were no differences in the NIHSS score,and NGF,BDNF,PT,APTT,FIB,and TT levels between the 2 groups(all P≥0.05).6 months after treatment,the NIHSS score of the observation group was significantly lower than that of the control group(t=2.551,P=0.014).After treatment of 2 weeks the NGF,BDNF,and FIB levels of the observation group were all significantly higher than those of the control group(t=12.048,P=0.000;t=8.389,P=0.000;t=6.574,P=0.000),and the TT level of the observation group was significantly lower than that of the control group(t=2.891,P=0.000),however,there were no significant differences in the PT and APTT levels between the two groups(both P≥0.05).There were no significant differences in the mild disability rate and mortality between the 2 groups(both P≥0.05);the severe disability rate of the observation group was significantly lower than that of the control group(χ^(2)=4.920,P=0.027),and the recovery rate of the control group was significantly higher than that of the control group(χ^(2)=4.480,P=0.034).Results With a good clinical effect,mechanical ventilation combined with Salvia miltiorrhi‐za polyphenolate in the treatment of severe craniocerebral injury improves the neurological function and coagulation function of the patients,thus improving the prognosis greatly.
作者
王维刚
赵利珍
李俊霞
WANG Weigang;ZHAO Lizhen;LI Junxia(ICU,Linyi Jinluo Hospital,Linyi Shandong 276036,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第9期996-999,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
河北省医学科学研究重点课题计划(编号:20181731)。
关键词
机械通气
丹参多酚酸
重症颅脑损伤
神经功能评分
Mechanical ventilation
Salvia miltiorrhiza polyphenolate
Severe craniocerebral injury
Neurological func‐tion score
