CAJ | 학술논문

目的：探讨盐酸纳洛酮对中、重型颅脑损伤的临床作用。方法2010～2012年间收治的124例中、重型颅脑损伤患者随机分为盐酸纳洛酮治疗组（治疗组）和常规治疗对照组（对照组），每组各62例，两组患者在年龄、病变部位、格拉斯哥昏迷量表（ GCS）评分及手术方式均无显著差异。对照组给予常规降颅内压、清除血肿或去骨瓣手术、对症支持治疗，治疗组在此基础上加用盐酸纳洛酮0．3 mg／（ kg· d）连续7 d治疗，观察两组患者的颅内压变化及预后。结果对照组3、5、7 d的颅内压分别为（2．86±0．34） kPa、（2．51±0．39）kPa、（2．26±0．38）kPa；而治疗组的颅内压依次为（2．48±0．40）kPa、（2．21±0．44）kPa、（2．10±0．38）kPa，比同期对照组均有显著降低（均P＜0．05）。对照组预后良好、中残、重残、死亡的患者分别为21、19、9、13例，而治疗组依次为38、13、5、6例，治疗组的预后比对照组显著改善（ P＜0．05）。结论在包括手术、脱水药物、亚低温以及抗癫痫、神经营养药物等在内的传统综合疗法基础上，盐酸纳洛酮能进一步缓解颅内压增高，改善重症颅脑损伤患者的预后，有较高临床推广价值。
목적：탐토염산납락동대중、중형로뇌손상적림상작용。방법2010～2012년간수치적124례중、중형로뇌손상환자수궤분위염산납락동치료조（치료조）화상규치료대조조（대조조），매조각62례，량조환자재년령、병변부위、격랍사가혼미량표（ GCS）평분급수술방식균무현저차이。대조조급여상규강로내압、청제혈종혹거골판수술、대증지지치료，치료조재차기출상가용염산납락동0．3 mg／（ kg· d）련속7 d치료，관찰량조환자적로내압변화급예후。결과대조조3、5、7 d적로내압분별위（2．86±0．34） kPa、（2．51±0．39）kPa、（2．26±0．38）kPa；이치료조적로내압의차위（2．48±0．40）kPa、（2．21±0．44）kPa、（2．10±0．38）kPa，비동기대조조균유현저강저（균P＜0．05）。대조조예후량호、중잔、중잔、사망적환자분별위21、19、9、13례，이치료조의차위38、13、5、6례，치료조적예후비대조조현저개선（ P＜0．05）。결론재포괄수술、탈수약물、아저온이급항전간、신경영양약물등재내적전통종합요법기출상，염산납락동능진일보완해로내압증고，개선중증로뇌손상환자적예후，유교고림상추엄개치。
Objective To investigate the clinical effects of naloxone hydrochloride for patients with medium-heavy craniocerebral injury .Methods 124 patients with medium-heavy craniocerebral injury enrolled in our hospital were randomized into Treating group and control group evenly , and two groups showed no difference in ages , lesional location, Glasgow coma scale and surgical procedure between .Patients in control group received symptomatic treatment and conventional operation of reducing intracranial hypertension , cleaning hematoma or decompressing bone flap while victims from control group were subjected to a additional administration of naloxone hydrochloride (0.3mg/kg/d· 7d). The variance of intracranial tension and prognosis were observed .Results The intracranial tension of control group in the 3rd, 5th, 7th days were (2.86 ±0.34)kPa, (2.51 ±0.39) kPa, (2.26 ±0.38)kPa respectively, while Treating group were (2.48 ±0.40) kPa, (2.21 ±0.44) kPa, (2.10 ±0.38) kPa which were significantly lower than the corresponding period of Control group (all P<0.05).Prognostically, the cases with outcome of favorable prognosis , death, medium handicap or severe handicap in treating group were 38,13,5,6, which were markedly better than treating control group (21,19,9,13 cases, respectively;P<0.05).Conclusion Based on traditional comprehensive therapies including operation , dehydrating drugs, mild hypothermia, anticovulsants and neural nutrition medicine , naloxone hydrochloride could further alleviate the intracranial hypertension , improve the prognosis of patients with medium-heavy craniocerebral injury and presented with high clinic value .