磷酸肌酸钠辅助治疗急性重型颅脑损伤的疗效评价

Evaluation of curative effect of creatine phosphate in treatment of patients with acute severe head injury

目的：探讨磷酸肌酸钠用于急性重型颅脑损伤手术的辅助治疗作用,为急性重型颅脑损伤的救治提供临床依据。方法：选择急性重型颅脑损伤手术40例患者,随机分为：磷酸肌酸钠组（n=20）和对照组（n=20）,磷酸肌酸钠组给予对照组相同的治疗基础上于术中输注磷酸肌酸钠2 g,记录输注前、输注后、硬脑膜切开、输注后2 h和手术结束时5个时点（T1T5）血流动力学参数,包括平均动脉压（MAP）、心率（HR）、心排出量（CO）、每搏指数（SI）、肺血管阻力（PVR）、颅内压（ICP）及脑氧分压（PbrO2）。测量术前及术后血S100β蛋白含量,记录术后恶心、寒战等不良反应病例,并于术后3个月时根据GOS评估法判定疗效。结果：术中,两组各时点MAP和HR差异无显著性。CO和SI在T2T5时,磷酸肌酸钠组明显高于对照组（t=4.019,P〈0.05）,磷酸肌酸钠组PVR则明显低于对照组（t=3.517,P〈0.05）。T5时磷酸肌酸钠组ICP低于对照组,同时前者PbrO2则高于后者（P〈0.05）。血S100β蛋白含量术后24 h与基础值差值比较,磷酸肌酸钠组上升值明显小于对照组（P〈0.05）。预后,磷酸肌酸钠组良好9例、中残4例、重残2例、植物生存3例和死亡2例,对照组良好2例、中残4例、重残6例、植物生存2例和死亡6例（U=116.0,P〈0.05）,磷酸肌酸钠组治疗有效率高于对照组（P〈0.05）。结论：急性重型颅脑损伤术中应用磷酸肌酸钠可增加心肌收缩力,改善心、脑组织微循环及能量代谢,促进预后。

Objective To investigate the clinical adjunctive therapeutical effect of creatine phosphate on the patients with acute severe head injury during operation to provide key material for study on its clinic therapeutic application.Methods 40 patients with acute severe head injury underwent operation were randomly divided into creatine phosphate group and control group.The patients in creatine phosphate group were injected with creatine phosphate（2 g）during operation.The patients in control group were administrated with saline i.v.with the same volume.mean arterial pressure（MAP）,heart rate（HR）,cardiac output（CO）,stroke volume index（SI）,pulmonary vascular resistance（PVR）,intracranial pressure（ICP） and brain partial pressure of oxygen（PbrO2）were recorded at pretreatment（T1）,after administration（T2）,after dura incision（T3）,2 h after administration（T4） and after operation（T5）.The content of protein S100β of per-patient was measured before and 24 h after operation,the cases of complication such as nausea,shivering and so on during operation were recorded after operation,according to Glasgow Outcome Scale（GOS）,the prognosis of the patients was evaluated.Results There was no markedly variation about MAP and HR between two groups on each time during opertion（P〉0.05）.Compared with control group,CO and SI were significantly higher in creatine phosphate group during operation（t=4.019,P〈0.05）at T2-T5,at the same time PVR in creatine phosphate group was notably lower than that in control group（t=3.517,P〈0.05）.After operation,ICP in creatine phosphate group was notably lower than that in control group,at the same time PbrO2 in control group was significantly higher than that in creatine phosphate group（P〈0.05）.After operation,the content of protein S100β in control group was significantly increased compared with before operation（P〈0.05）.The patients with GOS from grade Ⅰ to Ⅴ in creatine phosphate group were 9 cases,4 cases,2 cases,3 cases and 2 cases and those were 2 cases,4 cases,6 cases,2 cases and 6 cases in control group（U=116.10,P〈0.05）.The effective rate in creatine phosphate group was higher than that in control group（P〈0.05）.Conclusion Administration of creatine phosphate can increase myocardium contractility in patients with acute severe head injury during operation in earlier period,and can improve the microcirculation and energy metabolism of the heart and brain constitutions,and promote the rehabilitation of patients.