中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
4期
258-261
,共4页
赵明亮%杨细平%田竺%侯志勇%张赛
趙明亮%楊細平%田竺%侯誌勇%張賽
조명량%양세평%전축%후지용%장새
颅脑创伤,重型%亚低温%依达拉奉%肿瘤坏死因子-α%白细胞介素-6
顱腦創傷,重型%亞低溫%依達拉奉%腫瘤壞死因子-α%白細胞介素-6
로뇌창상,중형%아저온%의체랍봉%종류배사인자-α%백세포개소-6
Severe traumatic brain injury%Mild hypothermia%Edaravone%Tumor necrosis factor-α%Interleukin-6
目的：研究亚低温联合依达拉奉对重型颅脑创伤（sTBI）患者脑脊液肿瘤坏死因子-α（TNF-α）及白细胞介素-6（IL-6）表达及预后的影响。方法采用前瞻性随机对照研究方法，将武警后勤学院附属医院脑科中心收治的77例sTBI患者按随机数字表法分为对照组（38例）及治疗组（39例）。对照组给予脱水降颅压、营养脑神经、抗感染、呼吸机辅助呼吸及维持水电解质平衡等常规治疗，治疗组均于伤后24 h内在常规治疗基础上接受亚低温及依达拉奉治疗。采用放射免疫法测定两组患者不同时间点脑脊液TNF-α及IL-6含量，同时监测患者的颅内压（ICP）变化，并于伤后6个月根据格拉斯哥预后评分（GOS）判断预后。结果与对照组比较，伤后1 d治疗组患者脑脊液TNF-α及IL-6水平比较差异均无统计学意义（均P＞0.05），伤后3 d明显升高，7 d开始下降，14达谷值，且治疗组的降低程度较对照组更显著〔TNF-α（μg/L）：2.43±0.39比3.12±0.47，IL-6（ng/L）：83.53±11.48比101.69±13.64，均P＜0.01〕；两组治疗前ICP比较差异无统计学意义（P＞0.05），伤后1 d两组患者ICP逐渐升高，至伤后3 d达峰值，7 d开始下降，且以治疗组下降更显著〔mmHg（1 mmHg＝0.133 kPa）：14.88±3.73比21.76±4.78，P＜0.01〕。治疗组预后良好率较对照组明显升高〔35.9%（14/39）比21.1%（8/38），P＜0.05〕，病死率较对照组明显降低〔28.2%（11/39）比42.1%（16/38）， P＜0.05〕。结论亚低温联合依达拉奉可明显降低sTBI患者脑脊液TNF-α及IL-6表达水平，降低ICP，促进神经功能恢复，改善预后。
目的：研究亞低溫聯閤依達拉奉對重型顱腦創傷（sTBI）患者腦脊液腫瘤壞死因子-α（TNF-α）及白細胞介素-6（IL-6）錶達及預後的影響。方法採用前瞻性隨機對照研究方法，將武警後勤學院附屬醫院腦科中心收治的77例sTBI患者按隨機數字錶法分為對照組（38例）及治療組（39例）。對照組給予脫水降顱壓、營養腦神經、抗感染、呼吸機輔助呼吸及維持水電解質平衡等常規治療，治療組均于傷後24 h內在常規治療基礎上接受亞低溫及依達拉奉治療。採用放射免疫法測定兩組患者不同時間點腦脊液TNF-α及IL-6含量，同時鑑測患者的顱內壓（ICP）變化，併于傷後6箇月根據格拉斯哥預後評分（GOS）判斷預後。結果與對照組比較，傷後1 d治療組患者腦脊液TNF-α及IL-6水平比較差異均無統計學意義（均P＞0.05），傷後3 d明顯升高，7 d開始下降，14達穀值，且治療組的降低程度較對照組更顯著〔TNF-α（μg/L）：2.43±0.39比3.12±0.47，IL-6（ng/L）：83.53±11.48比101.69±13.64，均P＜0.01〕；兩組治療前ICP比較差異無統計學意義（P＞0.05），傷後1 d兩組患者ICP逐漸升高，至傷後3 d達峰值，7 d開始下降，且以治療組下降更顯著〔mmHg（1 mmHg＝0.133 kPa）：14.88±3.73比21.76±4.78，P＜0.01〕。治療組預後良好率較對照組明顯升高〔35.9%（14/39）比21.1%（8/38），P＜0.05〕，病死率較對照組明顯降低〔28.2%（11/39）比42.1%（16/38）， P＜0.05〕。結論亞低溫聯閤依達拉奉可明顯降低sTBI患者腦脊液TNF-α及IL-6錶達水平，降低ICP，促進神經功能恢複，改善預後。
목적：연구아저온연합의체랍봉대중형로뇌창상（sTBI）환자뇌척액종류배사인자-α（TNF-α）급백세포개소-6（IL-6）표체급예후적영향。방법채용전첨성수궤대조연구방법，장무경후근학원부속의원뇌과중심수치적77례sTBI환자안수궤수자표법분위대조조（38례）급치료조（39례）。대조조급여탈수강로압、영양뇌신경、항감염、호흡궤보조호흡급유지수전해질평형등상규치료，치료조균우상후24 h내재상규치료기출상접수아저온급의체랍봉치료。채용방사면역법측정량조환자불동시간점뇌척액TNF-α급IL-6함량，동시감측환자적로내압（ICP）변화，병우상후6개월근거격랍사가예후평분（GOS）판단예후。결과여대조조비교，상후1 d치료조환자뇌척액TNF-α급IL-6수평비교차이균무통계학의의（균P＞0.05），상후3 d명현승고，7 d개시하강，14체곡치，차치료조적강저정도교대조조경현저〔TNF-α（μg/L）：2.43±0.39비3.12±0.47，IL-6（ng/L）：83.53±11.48비101.69±13.64，균P＜0.01〕；량조치료전ICP비교차이무통계학의의（P＞0.05），상후1 d량조환자ICP축점승고，지상후3 d체봉치，7 d개시하강，차이치료조하강경현저〔mmHg（1 mmHg＝0.133 kPa）：14.88±3.73비21.76±4.78，P＜0.01〕。치료조예후량호솔교대조조명현승고〔35.9%（14/39）비21.1%（8/38），P＜0.05〕，병사솔교대조조명현강저〔28.2%（11/39）비42.1%（16/38）， P＜0.05〕。결론아저온연합의체랍봉가명현강저sTBI환자뇌척액TNF-α급IL-6표체수평，강저ICP，촉진신경공능회복，개선예후。
Objective To study the effect of mild hypothermia combined with edaravone on the expressions of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in cerebrospinal fluid(CSF)of patients with severe traumatic brain injury(sTBI)and on their prognoses. Methods A prospective randomizd controled trial was conducted. Seventy-seven patients in the Center for Neurology and Neurosurgery of Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces were randomly assigned into control group(38 cases)and treatment group(39 cases)according to random number table. All the patients were treated with routine treatments such as dehydration of intracranial pressure(ICP),neural nutrition,anti-infection,mechanical ventilation and maintenance of water and electrolyte balance in control group,while in treatment group,the patients received mild hypothermia combined with edaravone on the basis of routine treatment within 24 hours after injury. The contents of TNF-αand IL-6 in CSF were measured by radio-immunoassay(RIA)at different time points in both groups. In the meantime,the ICP was also measured. The prognosis was evaluated after 6 months of injury according to Glasgow outcome scale(GOS). Results Compared to control group,in the treatment group,the expression levels of TNF-αand IL-6 in CSF had no significant difference(both P>0.05)on the 1st day after injury,but they were significantly increased on the 3rd day after injury,began to decline on the 7th day,and reached to the valley value on the 14th day after injury,the degree of descent in treatment group being more significant than that in control group〔TNF-α(μg/L):2.43±0.39 vs. 3.12±0.47,IL-6(ng/L):83.53±11.48 vs. 101.69±13.64,both P<0.01〕. Before the treatment,the level of ICP in treatment group had no significant difference from that of control group(P>0.05),but it was gradually increased on the 1st day after injury in both groups,it reached the peak value on the 3rd day after injury,and began to decline on the 7th day after injury,the degree of descent being more significant in treatment group〔mmHg(1 mmHg=0.133 kPa):14.88±3.73 vs. 21.76±4.78,P<0.01〕. The favorable prognosis rate was significantly higher〔35.9%(14/39)vs. 21.1%(8/38),P<0.05〕,and the mortality was obviously lower in treatment group than those of control group〔28.2%(11)vs. 42.1%(16),P<0.05〕. Conclusion In patients with sTBI,mild hypothermia combined with edaravone can protect brain tissue through alleviating high ICP and decreasing the expression levels of TNF-αand IL-6 in CSF, resulting in promoting the recovery of nerve functions and improving prognosis.
