盐酸纳洛酮对中、重症颅脑损伤的作用研究

Study on effects of Naloxone hydrochloride for patients with medium to severe craniocerebral injury

目的探讨盐酸纳洛酮对中、重型颅脑损伤的临床作用。方法 2010~2012年间收治的124例中、重型颅脑损伤患者随机分为盐酸纳洛酮治疗组（治疗组）和常规治疗对照组（对照组）,每组各62例,两组患者在年龄、病变部位、格拉斯哥昏迷量表（GCS）评分及手术方式均无显著差异。对照组给予常规降颅内压、清除血肿或去骨瓣手术、对症支持治疗,治疗组在此基础上加用盐酸纳洛酮0.3 mg/（kg·d）连续7 d治疗,观察两组患者的颅内压变化及预后。结果对照组3、5、7 d的颅内压分别为（2.86±0.34）k Pa、（2.51±0.39）k Pa、（2.26±0.38）k Pa;而治疗组的颅内压依次为（2.48±0.40）k Pa、（2.21±0.44）k Pa、（2.10±0.38）k Pa,比同期对照组均有显著降低（均P〈0.05）。对照组预后良好、中残、重残、死亡的患者分别为21、19、9、13例,而治疗组依次为38、13、5、6例,治疗组的预后比对照组显著改善（P〈0.05）。结论在包括手术、脱水药物、亚低温以及抗癫痫、神经营养药物等在内的传统综合疗法基础上,盐酸纳洛酮能进一步缓解颅内压增高,改善重症颅脑损伤患者的预后,有较高临床推广价值。

Objective To investigate the clinical effects of naloxone hydrochloride for patients with medium-heavy craniocerebral injury .Methods 124 patients with medium-heavy craniocerebral injury enrolled in our hospital were randomized into Treating group and control group evenly , and two groups showed no difference in ages , lesional location, Glasgow coma scale and surgical procedure between .Patients in control group received symptomatic treatment and conventional operation of reducing intracranial hypertension , cleaning hematoma or decompressing bone flap while victims from control group were subjected to a additional administration of naloxone hydrochloride （0.3mg/kg/d＆#183; 7d）. The variance of intracranial tension and prognosis were observed .Results The intracranial tension of control group in the 3rd, 5th, 7th days were （2.86 ±0.34）kPa, （2.51 ±0.39） kPa, （2.26 ±0.38）kPa respectively, while Treating group were （2.48 ±0.40） kPa, （2.21 ±0.44） kPa, （2.10 ±0.38） kPa which were significantly lower than the corresponding period of Control group （all P〈0.05）.Prognostically, the cases with outcome of favorable prognosis , death, medium handicap or severe handicap in treating group were 38,13,5,6, which were markedly better than treating control group （21,19,9,13 cases, respectively;P〈0.05）.Conclusion Based on traditional comprehensive therapies including operation , dehydrating drugs, mild hypothermia, anticovulsants and neural nutrition medicine , naloxone hydrochloride could further alleviate the intracranial hypertension , improve the prognosis of patients with medium-heavy craniocerebral injury and presented with high clinic value .