ICU控制性机械通气联合大剂量纳洛酮治疗脑肿胀的临床观察

ICU controlled mechanical ventilation with high-dose naloxone in treatment of brain swelling

目的探讨控制性机械通气联合大剂量纳洛酮治疗外伤性急性弥漫性脑肿胀(PADBS)的机制与疗效。方法选择伤后12 h内入院的PADBS患者28例(治疗组)接受控制性机械通气联合大剂量纳洛酮治疗;仅在出现呼吸功能障碍时使用机械通气和未用纳洛酮治疗的同类患者11例作为对照组。所有患者其它治疗措施均基本相同。同时监测病人的生命体征、血糖、血乳酸、血气、血电解质、头颅CT。均于伤后2个月时根据GOS评估法判定疗效。结果与对照组相比,控制性机械通气联合大剂量纳洛酮治疗组高颅内压(ICP)、高血糖、高乳酸血症分别明显下降;脑灌注压(CPP)明显上升;无严重并发症。结论 PADBS患者早期应用控制性机械通气联合大剂量纳洛酮治疗可明显提高临床疗效,缩短昏迷时间,减少并发症发生。

Objective To study mechanism and efficacy of the controlled mechanical ventilation with high-dose naloxone in treatment of traumatic acute diffuse brain swelling（PADBS）.Methods With n 12 h after injury PADBS admitted,28 patients（treatment group） received controlled mechanical ventilation with high-dose naloxone treatment of respiratory dysfunction only in the use of mechanical ventilation and non-similar in patients treated with naloxone 11 cases as the control group.Other therapeutic measures of the patients were basically same.The patient＇s vital signs,blood glucose,blood lactate,blood gas,serum electrolytes,head CT were observed.Results Compared with the control group,controlled mechanical ventilation with high-dose naloxone treatment group,high intracranial pressure（ICP）,high blood sugar,lactic acidosis showed a significant decline;cerebral perfusion pressure（CPP） of treatment grouop significantly increased.Conclusion PADBS early application of controlled mechanical ventilation in patients with high-dose naloxone treatment can significantly improve the clinical efficacy,shorten the duration of coma and reduce complications.