血必净注射液对重度颅脑损伤患者血浆内皮素影响的研究及临床意义

Study on effects of Xuebijing injection (血必净注射液) on changes of plasma endothelin of patients with severe craniocerebral injury and clinical significance of the changes

目的探讨血必净注射液治疗重度颅脑损伤患者血浆内皮素(ET)含量的变化及其临床意义。方法61例重度颅脑损伤患者被随机分为两组。对照组30例给予常规治疗;治疗组31例在常规治疗基础上于伤后2 d给予血必净注射液100 ml/d,连续用7 d。分别于伤后1、3、5和7 d采血,用特异性免疫分析法测定血浆中ET的含量;于治疗前及治疗3 d和7 d观察两组患者的格拉斯哥昏迷评分(GCS评分)变化及应激性溃疡发生率。结果伤后1 d两组患者血浆ET含量均较正常参考值明显升高,但两组间比较差异无统计学意义(P>0.05);自伤后3 d起两组患者血浆ET含量均呈明显下降趋势,且治疗组明显低于对照组(P<0.05或P<0.01)。治疗组应激性溃疡的发生率也明显低于对照组[22.58%(7/31)比46.67%(14/30),P<0.01]。治疗后两组GCS评分较治疗前均有所增高,至7 d时差异有统计学意义(P均<0.05),且治疗组明显高于对照组(P<0.05)。结论重度颅脑损伤患者血浆ET含量明显升高,与病情轻重有关,血必净注射液较常规治疗能更迅速降低血浆ET含量,减轻继发性脑损伤,降低应激性溃疡的发生率,改善预后。

Objective To investigate the effects of Xuebijing injection （血必净注射液） on the changes of plasma endothelin （ET） in patients with severe craniocerebral injury and the clinical significance of the changes. Methods Sixty-one patients with severe craniocerebral injury were enrolled in this study. Thirty-one patients with severe craniocerebral injury treated routinely, and after 2 days they were treated by Xuebijing injection （100 ml per day） consecutively for 7 days. The other 30 patients with similar craniocerebral injury were routinely treated for a parallel-control test. After trauma, on the 1st, 3rd, 5th and 7th days, blood was collected, respectively. The plasma concentrations of ET were analyzed by radioimmunoassay, and before the treatment and 3 and 7 days after the therapeutic course, the incidence of stress gastric ulcer and the changes of score of Glasgow Coma Scale （GCS） were observed. Results The plasma concentrations of ET were increased on the 1st days after treatment; there was no significant difference between the two groups （P〉0.05）. But the plasma concentrations of ET were decreased markedly on the 3rd days in both groups; the values of ET in Xuebijing injection group were significantly more declined than those in control group （P〈0.05 or P〈0.01）. The incidence of stress gastric ulcer was 22.58 % （7/31） in Xuebijing injection group, which was significantly lower than that in control group [46.67% （14/30）, P〈0. 01]. After treatment, the scores of GCS were increased in both groups （P〈0.05）; the GCS score in Xuebijing injection group was significantly higher than that in control group on the 7th days （P〈0. 05）. Conclusion The plasma ET levels are increased significantly after severe craniocerebral injury and correlated with the severity of patient＇s condition. Compared with the routine treatment, Xuebijing injection treatment may obtain better therapeutic results in decreasing plasma ET levels, ameliorating the secondary craniocerebral injury, reducing the incidence of stress gastric ulcer and improving the prognosis.