终池引流对重型颅脑损伤患者脑脊液中血管活性物质含量的影响

Effect of terminal cistern continuous drainage on blood vessel active substance in cerebrospinal fluid of acute severe brain injury

目的 探讨终池持续引流对急性重型颅脑损伤患者脑脊液中内皮素 (ET)及降钙素基因相类肽 (CGRP)含量的影响。方法 急性重型颅脑损伤患者 5 2例 ,随机分成终池持续引流组2 6例 (A组 )和常规腰穿组 2 6例 (B组 )。正常对照组 12例 (C组 ) ,用放射免疫法测定A、B两组不同时点及C组的脑脊液 (CSF)中ET及CGRP的含量。结果 A组引流量明显多于B组 (P <0 .0 1)。第 1天A、B两组CSF中ET及CGRP含量差异无统计学意义 (P >0 .0 5 ) ,但两组ET含量均高于C组 (P <0 .0 5 ) ,CGRP含量均低于C组 (P <0 .0 5 )。第 3、5天 ,ET含量B组高于A组 (P <0 .0 5 ) ,A组高于C组 (P <0 .0 5 ) ,CGRP含量B组低于A组 (P <0 .0 5 ) ,A组低于C组 (P <0 .0 5 )。第 7天 ,ET含量B组高于A组 (P <0 .0 1) ,A组略高于C组 ,但差异无统计学意义 (P >0 .0 5 ) ,CGRP含量B组低于A组 (P <0 .0 1) ,A组略低于C组 ,但差异无统计学意义 (P >0 .0 5 )。结论 终池持续引流较常规治疗方法能更有效抑制CSF中ET含量的上升趋势 ,能抑制CGRP含量的下降幅度 ,对减轻脑血管痉挛有一定的作用。

Objective To investigate the curative effect of terminal cistern continuous drainage on ET,CGRP in cerebrospinal fluid of acute severe brain injury.Methods Forty two patients with acute severe brain injury were randomly divided into two groups:Terminal cistern continuous drainage group (group A, n = 26),routine lumbar puncture group (group B, n = 26).There were 12 cases in normal control group (group C).Radioimmunoassay was used to measure the endothelin (ET) and calcitonin gene related peptide (CGRP) contents in cerebrospinal fluid in groups A and B at different time points and group C.Results In group A,the drainage amount of CSF was greater than in group B ( P < 0.01). On the first day,there was no significant difference in the contents of ET and CGRP between groups A and B in CSF ( P > 0.05), but the contents of ET in groups A and B were higher than in group C ( P < 0.05). On the third and fifth day,ET in group B was higher than in group A ( P < 0.05), while that in group A was higher than in group C ( P < 0.05). CGRP in group B was lower than in group A ( P < 0.05), while that in group A was lower than in group C ( P < 0.05). On the seventh day,ET in group B was higher than in group A ( P < 0.01), while that in group A was slightly lower than in goup C ( P > 0.05). CGRP in group B was lower than in group A ( P < 0.01), while that in group A slightly lower than in group C ( P > 0.05). Conclusion Terminal cistern continuous drainage can effectively inhibit the increased contents of ET and decreased contents of CGRP in CSF,which can alleviate cerebral vessels spasm.