大剂量甲泼尼龙与地塞米松治疗重度颅脑外伤的比较

Comparisons between large dose of methylprednisolone and dexamethasone in treatment of severe craniocerebral injuries

目的：探讨大剂量甲泼尼龙与常规剂量地塞米松在治疗重度颅脑外伤中的疗效比较。方法：重度颅脑外伤病人８１例，男性６５例，女性１６例；年龄３７±ｓ１７ａ，分为甲泼尼龙治疗组及地塞米松对照组，伤后６ｈ内治疗组给予甲泼尼龙３０ｍｇ／（ｋｇ·ｄ）×１ｄ，随后１０ｍｇ／（ｋｇ·ｄ）×３ｄ，以后７ｄ逐渐减量至停药。对照组给予常规剂量地塞米松２０～４０ｍｇ／ｄ［１］×５ｄ，以后２ｗｋ内逐步停药。结果：治疗组死亡率１９％，对照组死亡率４２％（Ｐ＜０．０５），并发症发生率无显著性差异（Ｐ＞０．０５）。结论：大剂量甲泼尼龙治疗重度颅脑外伤优于地塞米松。

AIM: To compare between the efficacies of large doses of methylprednisolone (Met) and conventional doses of dexamethasone (Dex) in the treatment of severe head injuries. METHODS: Eighty-one patients (M 65, F 16; age 37±s 17 a) with severe head injuries were divided into 2 groups: (1)Met group was given 30 mg/(kg·d) 6 h after injuries on d 1 and then in decreasing dosages within 7 d; and (2) Dex group was given conventional doses of Dex 20-40 mg/d×5 d, which was decreased in 2 wk. RESULTS: The mortalities in the Met and Dex groups were 19% and 42%, respectively (P<0.05). No significant difference in incidences of complications between groups (P>0.05). CONCLUSION: Large doses of Met is more effective than the conventional doses of Dex in the treatment of severe head injuries.