早期应用纳络酮治疗急性重型颅脑外伤对照观察

The influence of naloxone on acute severe brain injuries.

目的 探讨早期应用纳络酮对急性重型颅脑外伤的影响。方法 对 95例重型颅脑损伤病人随机分成纳络酮 (NLX)治疗组 (n =48)和对照组 (n =47) ,观察治疗早期病人生命体征、颅内压、头颅CT征变化和远期疗效 ,进行统计学分析。结果 纳络酮治疗组病人呼吸循环较快恢复稳定 ,呼吸异常 ( 2 9 2 % )和心律异常 ( 3 1 3 % )明显减少 (P <0 0 1)。伤后 1周内NLX组病人颅内压显著升高和重度脑水肿者较对照组明显减少 (P <0 0 1)。NLX组治疗 1周后意识转清醒率( 5 4 2 % )高于对照组的 40 4% (P <0 0 5 ) ,伤后 3个月恢复良好率显著高于对照组 ,重残率明显减少 (P <0 0 5 )。结论 早期大剂量运用纳络酮可以降低重型颅脑外伤病人颅内压的升高幅度 ,缩短昏迷时间 ,降低伤残率 ,促进病人神经功能恢复。

Objective To study the effect of naloxone (NLX) on acute severe brain injuries. Methods A retrospective review of 95 patients with severe traumatic head injury (48 cases were tearted with MLX and 47 cases were control) was done on clinical data and neurological outcome. Results The fluctuation of vital signs in the first 3 days was smoother in NLX group than in control, including arrhythmia(15 versus 27, P <0.01) and abnormal respiration (14 versus 29, P <0.01). CT scanning and lumbar puncture showed that the severity of brain edema and increase of intracranial pressure was less remarkable (10 versus 19 and 10 versus 20, P <0.01) after treatment of NLX for one week. More patients revived in NLX group than in control (26 versus 19, P <0.05) in 7 days accompanied by higher recovery rate (20 versus 15, P <0.05) and lower disability one (9 versus 15, P <0.05) after three months. Conclusions A successive large dosage of NLX can relieve traumatic brain edema and improve the recovery of coma and reduce the disability in severe brain injuries.