单唾液酸四己糖神经节苷脂钠对脑损伤所致脑水肿的影响研究

Effects of Monosialotetrahexosyl Ganglioside Sodium on Brain Edema Induced by Brain Injury

目的：观察单唾液酸四己糖神经节苷脂钠（GM1）治疗对脑损伤所致脑水肿的临床疗效。方法：78例脑损伤致脑水肿患者随机分为治疗组与对照组,各39例。对照组予常规治疗。治疗组加用GM1,急性期（2周）100 mg加入100ml生理盐水中,ivgtt,qd;维持期（2周）20 mg肌注,每日1-2次。4周为1个疗程。测算脑水肿面积,行格拉斯哥昏迷（GCS）评分,测定血清中一氧化氮（NO）和一氧化氮合酶（NOS）,记录不良反应。结果：治疗前,治疗组与对照组的GCS评分分别为（9.6±1.0）分和（9.8±1.3）分,治疗后分别为（12.9±1.6）分和（11.2±1.5）分,均较治疗前提高（P〈0.05或P〈0.01）,且治疗组更高（P〈0.05）。两组治疗7d水肿面积均明显增大（P〈0.01）,治疗14、28 d均明显缩小（P〈0.01）;组间比较,治疗组治疗7、14、28 d脑水肿面积均明显较小（P〈0.05或P〈0.01）。治疗组NO、NOS均显著降低（P〈0.01）,组间比较差异均有统计学意义（P〈0.01）。两组均无严重不良反应出现。结论：GM1治疗脑损伤所致脑水肿,可明显降低水肿面积、NO及NOS,改善GCS评分。

OBJECTIVE： To evaluate the effects of monosialotetrahexosyl ganglioside sodium （GM1） on brain edema induced by brain injury. METHODS： 78 patients with brain edema induced by brain injury were randomly divided into control group and treatment group with 39 cases in each group. The control group received conventional treatment. The treatment group was additionally treated with GM1 100 mg added into 100 ml normal saline intravenously once a day at acute stage （2 weeks） ; received intramuscular injection of GM1 20 mg once to twice a day. A treatment course lasted for 4 weeks. The brain edema area was calculated and glasgow coma scale （GCS） was scored. The serum level of nitric oxide （NO） and nitric oxide synthase （NOS） were determined, and ADR were recorded. RESULTS： Before treatment, GCS of control group and treatment group were （9.6 ±1.0） and （9.8± 1.3）, respectively; after treatment, they were （ 12.9± 1.6） and （ 11.2 ± 1.5）, both increased greatly （P〈0.05 or P〈0.01 ）, and the treatment group was much higher （P〈0.05）. The brain edema area increased greatly in 2 groups after 7 d of treatment （P〈0.01）, while decreased significantly after 14 d and 28 d of treatment （P〈0.01）. The brain edema area of treatment group was obvious smaller than control group after 7, 14 and 28 d of treatment （P〈0.05 or P〈0.01）. The levels of NO and NOS in treatment group decreased greatly （P〈0.01）, and there were statistically significant differences between two groups （P〈0.01）. No severe ADR was observed in two groups. CONCLUSIONS： For the patients with brain edema after brain injury, GM1 can decrease the brain edema area, the level of NO and NOS, and improve GCS.