CAJ | 학술논문

目的探讨血肿腔内注入盐酸纳洛酮治疗中重度颅脑损伤的疗效及安全性。方法86例中重度颅脑损伤患者随机分成对照组（n＝26）、静脉滴注纳洛酮组（n＝30）和血肿腔内灌注纳洛酮组（n＝30），观察各组生命体征、意识复苏时间、血浆β-内啡肽（β-EP）的变化，3个月后进行格拉斯哥预后评分（GOS）。结果纳洛酮治疗组患者的血液及呼吸循环恢复稳定较快。腔内注入纳洛酮组的意识复苏时间比对照组和静脉滴注纳洛酮组明显缩短（P＜0．01）。治疗后第10天，纳洛酮治疗组比对照组的 GCS 上升，且血肿腔内灌注组较静脉滴注纳洛酮组升高明显（P＜0．05）。而血肿腔灌注纳洛酮组β-EP 含量显著低于静脉滴注组及对照组（P＜0．05）。随访3个月后静脉滴注组患者 GOS 比对照组升高，而且血肿腔内灌注组较静脉滴注纳洛酮组升高明显（P＜0．05）。结论血肿腔内灌注纳洛酮可能通过拮抗β-EP 的作用，缩短中重度颅脑损伤昏迷时间，促进患者神经功能恢复，改善预后。
목적탐토혈종강내주입염산납락동치료중중도로뇌손상적료효급안전성。방법86례중중도로뇌손상환자수궤분성대조조（n＝26）、정맥적주납락동조（n＝30）화혈종강내관주납락동조（n＝30），관찰각조생명체정、의식복소시간、혈장β-내배태（β-EP）적변화，3개월후진행격랍사가예후평분（GOS）。결과납락동치료조환자적혈액급호흡순배회복은정교쾌。강내주입납락동조적의식복소시간비대조조화정맥적주납락동조명현축단（P＜0．01）。치료후제10천，납락동치료조비대조조적 GCS 상승，차혈종강내관주조교정맥적주납락동조승고명현（P＜0．05）。이혈종강관주납락동조β-EP 함량현저저우정맥적주조급대조조（P＜0．05）。수방3개월후정맥적주조환자 GOS 비대조조승고，이차혈종강내관주조교정맥적주납락동조승고명현（P＜0．05）。결론혈종강내관주납락동가능통과길항β-EP 적작용，축단중중도로뇌손상혼미시간，촉진환자신경공능회복，개선예후。
Objective To study the curative effects and safety of naloxone injection into the hematoma cavity in patients with moderate and severe brain injury .Methods Eighty-six patients with moderate and severe brain injury patients were randomly divided into routine treatment group (n = 26) ,naloxone injection by intravenous infusion group(n= 30) and naloxone injection into hematoma cavity group (n = 30) .Vital signs ,consciousness recovery time and levels of plasma β-endorphin (β-EP) were observed and GOS score was evaluated after 3 months .Results The recovery time of blood circulation and respiration was shorter in naloxone group than routine treatment group .Con-sciousness recovery time in of hematoma cavity group was shorter than control group and intravenous infusion group ( P< 0 .01) .Ten days after therapy ,GCS of patients in naloxone treated group was higher than control group ,and the increasing of GCS in hematoma cavity group was more remarkable than intravenous infusion group (P< 0 .05) .Plas-ma β-EP level in hematoma cavity group was lower than intravenous infusion group ,and that in control group was lowest (P< 0 .05) .Three months after therapy ,GOS in intravenous infusion group was higher than control group , and the increasing of GOS in hematoma cavity group was more remarkable than intravenous infusion group ( P <0 .05) .Conclusion Naloxone injection into hematoma cavity could decreases β-EP levels and coma time ,enhance the recovering of neurological function and improve curative effect .