尼莫通救治急性重型颅脑损伤的临床研究

Clinical study on nimoton in patients with severe cerebral injury

目的 :研究尼莫通对急性重型颅脑损伤患者颅内压 (ICP)、脑灌注压 (CPP)的影响 ,并评价其治疗效果。方法 :6 0例成年重型颅脑损伤患者随机分为对照组和尼莫通治疗组 ,各 30例 ,均进行 ICP及 CPP监测并按Marshall降颅压措施进行治疗。治疗组加用尼莫通 2 0 mg/d,80 0～ 12 0 0μg/h均匀泵入。动态观察临床症状、ICP和 CPP变化 ,并于治疗后 1周及 3个月评定疗效。结果 :尼莫通组于治疗后 2 4小时 ICP开始下降 ,CPP开始回升 ;72小时尼莫通组和对照组 ICP分别为 (3.14± 1.2 3) k Pa(1k Pa=10 .2 0 cm H2 O)和 (3.6 9± 1.12 ) k Pa;CPP分别为 (8.6 7± 1.5 2 ) k Pa和 (8.13± 1.17) k Pa,差异显著 (P均 <0 .0 5 )。而且 ,尼莫通组所有患者脱水后ICP无反跳 ,对照组有 10例 (33.3% )患者出现反跳 ,ICP高出脱水前 10 % ;治疗 5日尼莫通组 ICP和 CPP已近正常 ,对照组治疗 7日才接近正常。治疗 1周时临床评估 ,尼莫通组 GCS为 (11.7± 2 .4)分 ,对照组为 (8.5±2 .3)分 ,P<0 .0 1;治疗后 3个月 GOS评分 ,尼莫通组良好率 43.3%、中残率 2 6 .7%、重残率 16 .7%、植物生存3.3%、死亡率 10 .0 % ;而对照组分别为 2 6 .7%、16 .7%、16 .7%、10 .0 %和 30 .0 %。结论 :尼莫通能显著降低急性重型颅脑损伤患者颅内压 ,

Objective: To study the effect of Ca 2+ blocker(nimoton) on changes in intracranial pressure(ICP),cerebral perfusion pressure (CPP),and assess its therapeutic effects on severe cerebral injury.Methods:60 adult patients were randomly divided into nimoton group and control group with 30 cases in each group.ICP and CPP were monitored in both groups.Marshall principle was followed in both groups.In nimoton group nimoton 20 mg/d was given in addition by a constant pump at the rate of 800 1 200 μg/h .The effects were assessed after one week and three months of treatment.Results:The levels of ICP and CPP gradually improved after 24 hour treatment in nimoton group,and no rebound was found after 72 hours treatment.ICP rebound was observed in 33 3% patients in control group after 72 hours treatment.The improvement of ICP and CPP was significant after 72 hours in both group (all P <0 05).ICP returned to normal after five days and seven days treatment in nimoton group and in control group,respectively.Glasgow coma score(GCS) was accessed clinically after one week′s treatment.The difference in improvement of GCS was significant between two groups( P <0 01).Glasgow outcome score(GOS) was performed after three months of treatment.In nimoton group and in control group,the rates of good recovery were 43 3% and 26 7%,that of moderate disability 26 7% and 16 7%,that of severe disability 16 7% and 16 7%,that of vegetative subsistence 3 3% and 10 0%,and that of death 10 0% and 30 0%,respectively.Conclusions:Ca 2+ blocker can obviously decrease the incidence and the duration of elevation of ICP,improve CPP and improve the living quality.There is no side effects found.