局部亚低温配合纳络酮治疗脑出血的临床研究

A clinical study of local mild hypothermia combined with Naloxone in the treatment of acute intracerebral hemorrhage

目的探讨局部亚低温、纳络酮以及两者结合治疗脑出血的疗效。方法将45例急性脑出血患者随机分为4组：对照组12例，在发病24h内给予6-氨基己酸，颅内压增高时予脱水剂等常规治疗；亚低温组11例，在常规治疗的基础上给予局部亚低温治疗3d，鼻咽温度控制在33～34℃；纳络酮组11例，在常规治疗的基础上给予静脉点滴纳络酮，每次4mg，每日1次，共14d；联合组11例，在常规治疗的基础上给予局部亚低温治疗和静脉点滴纳络酮。于入院时和治疗第14天行头颅CT扫描，以测定出血量和水肿量；并于治疗前、后采用欧洲卒中评分量表（ESS）评定患者神经功能。结果治疗前，4组间比较，出血量、水肿量和ESS评分差异均无统计学意义（P〉0．05）。治疗第14天，4组间的出血量比较，差异无统计学意义（P〉0．05）；亚低温组水肿量[（21．25±5．86）ml]与联合组[（19．44±4．74）ml]接近（P〉0．05），但明显低于纳络酮组[（27．71±6、15）ml，P〈0．05]和对照组[（35．40±9．83）ml，P〈0．05]，纳络酮组明显低于对照组（P〈0．05）。治疗后ESS评分由高到低分别是：联合组（75．58±9．97）分；亚低温组（64．06±8．23）分；纳络酮组（54．86±7．51）分；对照组（45．98±5．90）分，各组间的分值比较，差异均有统计学意义（P〈0．05）。结论局部亚低温和纳络酮静脉点滴治疗均能明显减轻脑出血患者的脑水肿，改善其神经功能缺损；亚低温在减轻脑水肿和改善神经功能缺损方面的作用均优于纳络酮；联合应用不能进一步减轻脑水肿，但对神经功能缺损的改善作用更明显。

Objective To observe the effect of local mild hypothermia and Naloxone in the treatment of acute intraeerebral hemorrhage. Methods Forty-five patients with acute intraeerebral hemorrhage were randomly divided into 4 groups： a control group （12 patients） , a hypothermia group （11 patients） , a Naloxone group （11 patients） and a hypothemrmia plus Naloxone group （11 patients）. The patients in the control group were managed with conventional interventions including the administration of 6-aminoeaproic acid within 24 hours and dehydrant when intraeranial pressure was high. Those in the hypothermia and Naloxone groups were treated with local hypothermia at 33 - 34℃ for 3 days or intravenous transfusion of Naloxone at 4 mg/d in addition to the conventional intervention. Those in the combination group were treated with local hypothermia and intravenous Naloxone in addition to the conventional intervention. Immediately after admission and 2 weeks after treatment, head CT scans were conducted to observe the volume of cerebral hematoma and edema. The patients＇ neurological function was scored according to the European Stroke Standards （ESS） before and after treatment. Results There was no significant difference among the 4 groups in terms of the volume of hematoma and edema or in their ESS scores before treatment. After treatment, any differences among the 4 groups with regard to hematoma volume were not significant. The volume of edema in the hypothermia group was similar to that in the combination group and significantly lower than that in the Naloxone and control groups. Hematoma volume in the Naloxone group was significantly lower than that in the control group. After treatment, the ESS scores were significantly higher in the combination group than that in hypothermia group, and scores in the hypothermia group were significantly higher than in the Naloxone group. ESS scores in the Naloxone group were significantly higher that in the control group. Conclusion Local mild hypothermia and Naloxone treatment can inhibit cerebral edema and enhance recovery of neurological function in patients with intraeerebral hemorrhage. Local mild hypothermia has advantages over Naloxone in inhibiting the development of cerebral edema and in promoting recovery of neurological function. Local mild hypothermia in combination with Naloxone further inhibits edema, and it can enhance neurological function to a greater extent.