摘要
目的 研究早期纠正神经元内的酸中毒对急性重型颅脑损伤患者的疗效及治疗机理。方法 16 4例患者 (格拉斯哥昏迷评分≤ 8分 )随机均分为纠酸组 (A)和对照组 (B)。A组于伤后 6h内手术 ,用异丙酚 (Pro)等麻醉诱导并气管插管 ,静滴Pro维持麻醉 ,同时监测颅内压 (ICP)、血糖、血乳酸、脑组织氧分压 (PbrO2 )、和颈静脉血氧饱和度 (SjvO2 )等。B组麻醉时用安氟烷和咪唑安定取代Pro ,其他同A组。 3个月后判定疗效。结果 与B组相比 ,A组患者伤后早期高ICP、高血糖、高血乳酸分别显著下降(P <0 0 5 ) ;低PbrO2 迅速恢复正常。结论 早期纠酸治疗可降低病死率 ,提高生存质量。监测血糖、血乳酸、PbrO2 、SjvO2 。
Objective To study the clinical effect and therapeutic mechanism of early correction of acidosis in patients with severe head injury.Methods 164 patients with severe head injury (Glasgow coma scale score of 8 or less on admission)were randomly divided into the treatment group(group A, 82 cases)and the control group(group B, 82 cases). All patients received early correction of acidosis in within 6 hours of the head injury. In the group A ,a bolus of propofol,fentanyl, norcuron were given the induction drugs. After induction and endotracheal intubation, propofol was infused . Meanwhile, intracranial pressure (IP), blood glucose, blood lactate, brain tissue oxygen (P brO 2) and jugular venous oxygen saturation(S jvO 2) were measured. In the group B, midazolam and enfluence were used for induction instead of propofol. After three months the prognosis of all patients was evaluated.Results In comparison with group B,the increased IP, hyperglycemia, blood lactate significantly decreased in the group A and cerebral flow improved significantly(P<0.05). Conclusion Early correction of acidosis in can reduce the mortality and improve the prognosis of the patients.Monitorings of blood glucose, blood lactate, P brO 2 and S jvO 2 are also important to evaluate the clinical effect of the therapy.
出处
《中华急诊医学杂志》
CAS
CSCD
2004年第3期194-196,共3页
Chinese Journal of Emergency Medicine
