依达拉奉联合纳美芬对急性重型颅脑损伤患者血清神经细胞因子和炎性因子的影响

Effect of Edaravone Combined with Nalmefene in Serum Nerve Cell Factors and Inflammatory Factors in Patients with Acute Severe Craniocerebral Injury

目的:探讨依达拉奉联合纳美芬对急性重型颅脑损伤患者血清神经细胞因子和炎性因子的影响。方法:选择2015年1月至2017年12月我院接诊的急性重型颅脑损伤患者80例,按照随机数字表法分为对照组(n=40)和观察组(n=40),对照组患者入院后接受常规综合治疗,观察组在此基础上给予依达拉奉联合纳美芬进行治疗,比较两组患者血清神经细胞因子、炎性因子水平及格拉斯哥昏迷评分(GCS)、急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分变化情况,观察两组患者颅内压情况、脑水肿情况以及不良反应发生情况。结果:观察组患者治疗后1d、治疗后1周血清β-内咖肽、S100β蛋白、神经特异性烯醇化酶(NSE)水平均低于治疗前和对照组(P<0.05)。两组患者治疗后1周血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平均较治疗前降低,且观察组低于对照组(P<0.05)。观察组患者治疗1周后颅内压<15 mm Hg所占比例及轻度脑水肿所占比例均高于对照组(P<0.05),而颅内压≥20 mm Hg所占比例及重度脑水肿所占比例均著低于对照组(P<0.05)。两组患者治疗后1周GCS评分较治疗前升高,APACHEⅡ评分较治疗前降低(P<0.05);且观察组治疗后1周GCS评分较对照组升高,APACHEⅡ评分较对照组降低(P<0.05)。两组患者不良反应发生率经统计分析差异无统计学意义(P>0.05)。结论:依达拉奉联合纳美芬能够明显改善急性重型颅脑损伤患者血清神经细胞因子和炎性因子水平,促进颅内压下降和脑水肿吸收,有利于提升患者预后,且安全性好。

Objective: To investigate the effect of edaravone combined with nalmefene in serum nerve cell factors and inflammatory factors in patients with acute severe craniocerebral injury. Methods: 80 patients with acute severe brain injury who were received in our hospital from January 2015 to December 2017 were selected, and they were randomly divided into control group(n=40)and observation group(n=40). The patients in the control group were received routine comprehensive treatment after admission, on this basis, the observation group were given edaravone combined with nalmefene treatment. The levels of serum nerve cell factors,inflammatory factors, Glasgow Coma Scale(GCS), acute physiology and chronic health status II(APACHE II) score were compared between the two groups, the intracranial pressure, brain edema and adverse reaction were observed in the two groups. Results: The levels of serum β-endorphin, S100β protein and neuron specific enolase(NSE) in the observation group at 1d and 1 week after treatment were lower than those before treatment and in the control group(P<0.05). The levels of serum high sensitivity C reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α), interleukin-8(IL-8) of patients in two groups at 1 week after treatment were lower than before treatment,and the observation group was lower than the control group(P<0.05). The proportion of intracranial pressure <15 mm Hg and the proportion of mild cerebral edema at 1 week after treatment in the observation group were higher than that of the control group(P<0.05),proportion of intracranial pressure ≥20 mm Hg and the proportion of severe brain edema proportion was lower than that of the control group(P<0.05). The score of GCS in the two groups was higher than that before treatment at 1 week after treatment, and the score of APACHE II was lower than that before treatment(P<0.05). The score of GCS in the observation group was higher than that of the control group at 1 week after treatment, and the score of APACHE II was lower than that of the control group(P<0.05). There was no statistically significant difference in the inci dence of adverse reactions between the two groups(P>0.05). Conclusion: Edaravone combined with nalmefene can significantly improve nerve cell factors and inflammatory factors levels of patients with acute severe craniocerebral injury,and it promotes the reduction of intracranial pressure and the absorption of brain edema, which is beneficial to the prognosis of the patients and has good safety.