脑震荡伤后症状群发生机制及早期药物治疗探讨

Pathogenesis and early drugs therapy of symptoms after concussion

目的探讨脑震荡伤后症状群发生机制及早期药物治疗的有效作用。方法选取113例脑震荡患者，随机分为3组早期分别给予灯盏细辛、尼莫地平、能量合剂三种药物治疗，伤后早期、晚期行SCL-90评分及脑电图（EEG）、脑血流经颅多普勒（TCD）检查，并与常模进行对照，分析各检查结果及不同药物疗效情况。结果113例患者伤后早期躯体化、强迫、抑郁、焦虑、敌对症状因子SCL-90评分（t=10．78、2．08、9．53、11．09、2．52，P〈0．01或P〈0．05）及晚期12例后遗症患者躯体化、抑郁、焦虑、恐怖和精神病性症状因子评分与正常人群差异有统计学意义（t=3．21、6．85、3．07、3．14、4．73，P均〈0．01），早期EEG检查57．4％异常，TCD检查67．0％异常；晚期EEG检查33．3％异常，TCD检查。25．0％异常。伤后14d灯盏细辛组患者脑震荡症状消失率45．0％，明显高于尼莫地平组23．7％（χ2=3．91，P〈0．05）及能量合剂组20．0％（χ2=5．25，P〈0．05）；伤后1个月症状消失率能量合剂组40．0％明显低于尼莫地平组68．4％（χ2=5．94，P〈0．05）及灯盏细辛组75．0％（χ2=9．43，P〈0．01）；伤后3个月后遗症发生率能量合剂组22．9％，明显高于尼莫地平组5．2％（χ2=4．77，P〈0．05）及灯盏细辛组5．0％（χ2=5．15，P〈0．05）。结论脑震荡伤后症状群的发生主要源于伤后脑组织器质性损伤，伤后心理因素的变化对症状的发生发展有影响；伤后早期应用扩血管药物治疗可促进脑震荡症状及时康复，减少后遗症的发生。

Objective To study the pathogenesis and the effect of early drugs therapy of symptoms after concussion. Methods One-hundred and thirteen patients with symptoms after suffered concussion enrolled in the study and divided randomly into three groups. The patients of different groups were treated respectively with drugs, i. e. erigeron breviscapus, nimodipine, energy mixture. Symptom Check-List 90 （ SCL-90 ） and electroencephalogram（EEG） and cerebral blood flow of trancranial Doppler（TCD） were examined in the early and late stage of post-concussion. Normal population were recruited as control. All examination results and the effect of treatment were compared between treatment group and control group. Results In the scores of SCL-90 , the factor scores of somatization symptom, compulsion, depressive disorder, anxiety disorders, and hostile symptom in 113 post-concussion patients in early stage were all higher than those in the normal（ t = 10.78,2.08, 9. 53,11.09 and 2. 52,P 〈0.01or P 〈0. 05） ,and as well as that of somatization symptom,depressive disorder, anxiety disorders,terror and mental disorder symptom in 12 post-concussion patients in late stage compared to normal（t =3.21,6. 85,3.07,3.14 and 4. 73 ,Ps 〈0. 01 ）. The test of EEG was abnormal in 57.4 % of patients in early stage and in 33.3% in the late stage. Of all TCD results,67.0 % was abnormal in the early stage and 25.0% in the late stage,The disappearance rate of post-concussion symptoms in the 14th day was significantly higher in the erigeron breviscapus group （ 45.0% ） than in the nimodipine group （ 23. 7% ） （χ2 = 3.91, P 〈 0. 05 ） and in the energy mixture group （ 20. 0% ） （ X2 = 5.25, P 〈 0. 05 ）. The disappearance rate of post- concussion symptoms in the 30th day in the energy mixture group（40. 0% ） was significantly lower than those in nimodipine group（68.4% ） （χ2 = 5.94 ,P 〈 0. 05 ） and in erigeron breviscapus group （75.0%） （ χ2 = 9. 43, P 〈 0. 01 ）. The occurrence rate of post-concussion sequelae was higher in the energy mixture group （ 22. 9% ） than in the nimodipine group （ 5.2% ） （χ2 = 4. 77, P 〈 0. 05 ） and in the erigeron breviscapus group （ 5.0% ） （ χ2 = 5.15, P 〈 0. 05） three month after injuries. Conclusion The occurrence of symptoms originated from the organic damage of brain tissue. However, its changes were influenced by psychologic factors after concussion. Early vasodilative drugs therapy could improve the recovery of patients with post-concussion symptoms in time and decrease the occurrence of post-concussion sequelae.