神经节苷脂钠注射液对急性重症颅脑损伤患者的脑保护作用

Cerebral protection mechanism of ganglioside sodium on patients with acute severe brain injury

目的评价神经节苷脂钠注射液对急性重症颅脑损伤患者中脑保护作用机制及预后改善效果。方法选择驻马店市中心医院重症医学科收治的47例急性重症颅脑损伤患者,根据治疗方式分为对照组(22例)和观察组(25例)。全部患者给予脱水、止血、抗炎、营养神经、亚低温脑保护或神经外科手术等治疗措施。观察组患者在以上治疗的基础上予以静脉滴注100 mg神经节苷脂钠+250 mL等渗盐水,每日1次,14 d后用量减少至40 mg,每日1次,疗程为3周。对2组患者治疗前、治疗后3、7、14、21 d的血肿瘤坏死因子-α(TNF-α)、血清内皮素1(ET-1)、血浆神经肽Y(NPY)、降钙素基因相关肽(CGRP)水平进行检测分析,并对全部患者进行3个月的电话及门诊随访,对2组患者的预后情况进行统计比较。结果 2组患者治疗后3、7、14、21 d血TNF-α、ET-1、NPY水平均显著低于治疗前,CGRP水平显著高于治疗前(P<0.05)。观察组患者治疗后3、7、14、21 d血TNF-α、ET-1、NPY水平显著低于对照组,CGRP水平显著高于对照组(P<0.05)。观察组患者的治愈率显著高于对照组(P<0.05)。结论急性重症颅脑损伤患者在脱水降颅压、外科手术等传统治疗的基础上加用神经节苷脂钠能够产生明显的脑保护效果,并使患者预后情况得到改善。

Objective To evaluate the cerebral protection mechanism of ganglioside sodium on patients with acute severe brain injury. Methods Forty-seven patients with acute severe brain injury from intensive care unit of the central hospital of Zhumadian city were divided into control group（22 cases） and observation group（25 cases） according to the treatment methods,all patients were given treatment of dehydration,hemostatic,antiphlogistic,trophic nerve,mild hypothermia brain protection or neurosurgical operation. Patients in observation group were given intravenous drip of 100 mg ganglioside sodium plus250 mL isotonic saline solution besides the above treatment,once a day,the dose decreased to 40 mg after 14 days,treatment course was three weeks. The levels of tumor necrosis factor α（TNF-α）,endothelin 1（ET-1）,neuropeptide Y（NPY） and calcitonin gene related peptide（CGRP） in blood before treatment and 3,7,14 and 21 days after treatment in the two groups were detected and analyzed,and all the patients were given telephone and outpatient follow-up for three months,and the prognosis of the two groups were compared. Results The TNF-α,ET-1 and NPY levels in blood of all the patients at 3,7,14 and 21 days after treatment were lower than those before treatment,while the CGRP level after treatment was higher than that before treatment significantly（P〈0. 05）. The TNF-α,ET-1 and NPY levels of patients in observation group at 3,7,14 and 21 days after treatment were lower than those of control group,while the CGRP level of observation group after treatment was higher than that of control group significantly（P〈0. 05）. The cure rate of observation group was higher than that of control group significantly（P〈0.05）. Conclusion Lowering the intracranial pressure,surgical operation and other traditional treatment combine with ganglioside sodium can produce clear protective effect of the brain,and can improve the prognosis of the patients with acute severe brain injury.