醒脑静治疗重型颅脑损伤疗效观察

Therapeutic effect of Xingnaojing on severe traumatic brain injury

目的 探讨醒脑静治疗重型颅脑损伤（severe traumatic brain injury,sTBI）的疗效和安全性。方法 60例sTBI患者随机分为对照组及观察组各30例,对照组给予脱水、抗感染、纠正水电解质紊乱、营养支持等常规治疗,并根据需要行标准颅脑外伤去大骨瓣开颅手术联合亚低温治疗,观察组在对照组治疗基础上给予醒脑静注射液30 mL＋生理盐水250mL,1次/d,连续7d。比较2组入院时、治疗7d后血清S100B蛋白、髓鞘碱性蛋白（myelin basic protein,MBP）和神经元特异性烯醇化酶（neuron-specific enolase,NSE）水平及格拉斯哥昏迷评分（Glasgow Coma Score,GCS）变化。结果 观察组、对照组治疗7d后血清S100B[（0.85±0.11）、（1.17±0.21）mg/L]、MBP[（6.49±1.01）、（9.35±1.72）mg/L]和NSE[（11.16±1.81）、（18.03±1.79）mg/L]水平均较入院时[S100B（1.62±0.23）、（1.61±0.38）mg/L,MBP（15.07±2.32）、（14.51±2.20）mg/L,NSE（37.51±1.84）、（37.27±1.96）mg/L]降低（P〈0.05）,观察组较对照组降低明显（P〈0.05）;观察组治疗7d后GCS评分〉12-15分比例（60.0%）高于对照组（30.0%）（P〈0.05）。结论 在常规治疗基础上应用醒脑静可降低sTBI患者血清S100B、MBP和NSE水平,改善患者昏迷程度。

Objective To study the therapeutic effect and safety of Xingnaojing in the treatment of severe traumatic brain injury （sTBI）. Methods Sixty patients with sTBI were randomly divided into control group and observation group, with 30 patients in each group. Control group received conventional treatment including dehydration, anti-infection, adjusting water-electrolyte imbalance and nutrition supporting, and were performed standard large eraniotomy plus hypothermia treatment, besides which observation group received intravenous injection of 30 mL Xingnaojing ＋ 250 mL normal saline once a day, totally for 7 days. The concentrations of S100B protein, myelin basic protein （MBP） and neuron-specific enolase （NSE） in plasma were recorded at admission and after 7-day treatment as well as the Glasgow Coma Score （GCS） after 7-day treatment and compared between two groups. Results The serum levels of S100B （（0.85±0.11）, （1.17± 0.21） mg/L）, MBP （（6. 49±1.01）, （9. 35±1. 72） mg/L） and NSE （（11. 16±1. 81）, （18. 03±1. 79） mg/L） in observation group and control group were lower after 7-day treatment than those at admission （S100B： （1.62 ± 0.23）, （1.61±0.38） rag/L; MBP：（15.07±2.32）, （14. 51±2. 20） ms/L; NSE： （37. 51±1. 84）, （37. 27±1. 96） mg/L） （P〈0.05）, which were more obvious in observation group than in control group （P〈0.05）. The percentage of GCS 12 to 15 after 7-day treatment in observation group （60.0%） was higher than that in control group （30.0%） （P〈0.05）. Conclusion Application of Xingnaojing plus the conventional therapy can reduce the concentrations of S100B, MBP and NSE, and alleviate the degree of coma in sTBI patients.