纳洛酮不同给药方式对急性重型脑损伤患者脑功能的影响

The Effect of Different Administration of Naloxone on Acute Severe Cerebral Injuries

目的:探讨纳洛酮治疗急性重型脑损伤不同给药方式对脑功能的影响。方法:选择受伤后12h内入院的急性脑损伤患者48例,按伤情轻重分为格拉斯哥昏迷评分(GCS)3～5分组和GCS 6～8分组。选用不同的给药方式,2mg或4mg静脉注射(A ,B组),4.8mg/d或0.3mg/(kg·d)持续静脉滴注(C,D组)。用定量脑电图监测,观察用药前、用药后10min,30min,1h,2h,4h脑电总功率值的变化。结果:GCS 6～8分组中,A ,B组纳洛酮用药10min后总功率值明显高于用药前(P<0.01),2h 后明显下降;C,D组用药后1h或30min后总功率值明显高于用药前,且呈持续性升高,多数时段P<0.01。GCS 3～5分组纳洛酮用药后总功率值增加与用药前无统计学差异(P>0.05)。结论:重型脑损伤急性期纳洛酮治疗宜选用首剂负荷量法。

Objective:To reveal the effects of different administration of naloxone on acute severe cerebral injuries.Methods:Forty eight patients with acute severe cerebral injuries(Glasgow Coma Scale 3～8,within 12 hours after injury) were selected for this study.According to the severity of injury,all patients were classified into GCS 3～5 and GCS 6～8 group.The different dose naloxone[2 mg/2 min,A group;4 mg/4 min,B group;4.8 mg/d,C group;0.3 mg/(kg·d),D group] were administered respectively to the patients with acute cerebral injury.Absolute power of 1-25 frequency were monitored with qEEG before and 0,10,30 minutes;1,2,4 hours after administration.Results:In GCS 6～8 group,absolute power of 1-25 frequency in A and B groups were significantly increased(P < 0.01) in qEEG after administration 10 min.In C or D group absolute power were significantly increased after administration 1 hour or 30 min and were increasing within 4 hours.In GCS 3～5 group,that parameter were not significantly different after administration.Conclusion:These results suggest that naloxone should be administered with bolus intravenous injection after acute severe cerebral injuries.