纳美芬辅助治疗颅脑损伤意识障碍的研究进展

Advances in nalmefene assisted treatment of disorders of consciousness due to craniocerebral injury

创伤性颅脑损伤(TBI)即颅脑创伤,是指因外力直接或间接作用于头颅所造成的脑部损伤,是神经创伤中的常见病,具有病情急、发病率高、致残率高及病死率高等特点。随着现代急诊处理及重症医学水平的进步,TBI救治后的存活率明显上升,但救治后常遗留不同程度的意识障碍,如最小意识状态、持续性植物状态、昏迷等。意识障碍患者不能进行功能性交流和意向性运动,只能长期卧床,依赖于他人的护理,给个人、家庭和社会经济带来了沉重的压力。因此,对TBI意识障碍患者进行促醒治疗具有重要意义。近十年来,纳美芬被广泛应用于治疗TBI等疾病引起的意识障碍,并取得了良好的临床效果。本文就纳美芬辅助治疗TBI意识障碍的有效性、安全性、可能作用机制及存在的一些问题进行综述,旨在促进纳美芬促醒治疗的规范化。

Traumatic brain injury(TBI) is a type of brain injury caused by external forces acting directly or indirectly on the skull, and it is a common neurotrauma, with acute condition, morbidity,disability and mortality. With the progress of modern emergency management and critical care medicine, the survival rate of TBI after the treatment has increased significantly, but different degrees of consciousness impairment are often found after the treatment, such as minimal consciousness,persistent vegetative state, coma and so on. Patients with impaired consciousness cannot functionally communicate and intentionally move. They are bedridden and have to rely on the care givers,which puts pressure on individuals, families and the society. It is important to practice wakefulnesspromoting for patients with consciousness disorders after TBI. In the past decade, nalmefene has been widely used in patients with disorders of consciousness caused by TBI and other diseases,and good clinical results have been achieved. This paper reviewed the effectiveness, safety and possible mechanism of nalmefene in the assisted treatment of consciousness disorders after TBI, and analyzed some problems in clinical application, aiming to promote the standardization of nalmefene wakefulness-promoting treatment.