rhEPO联合纳洛酮治疗重型颅脑损伤昏迷的临床效果观察

Clinical Effects of Recombinant Human Erythropoietin combined with Naloxone in the Treatment of Coma Patients Post Severe Craniocerebral Trauma

目的:探讨重组人促红细胞生成素(recombinant human erythropoietin,rh EPO)联合纳洛酮治疗重型颅脑损伤昏迷患者的临床效果。方法:选取2012年6月至2015年7月于佛山急诊抢救中心接受治疗的重型颅脑损伤昏迷患者160例,格拉斯哥昏迷量表(GCS)评分3~8分,将患者完全随机分为实验组和常规组,各80例。两组患者均给予生命监护、止血、激素以及局部亚低温等常规治疗,常规组静脉/肌内注射纳洛酮(0.01-0.02 ms/kg,若给药后无反应,3-5 min后重复1次,直至患者苏醒),后续给予纳洛酮2mg加入5%葡萄糖或0.9%氯化钠注射液中持续静脉滴注,给药时间为45-90 min;实验组在常规组基础上于治疗第1、4、7、10、13天皮下注射rh EPO 7 500 IU/次,持续2周。比较两组患者治疗前后GCS评分、转为清醒的时间、治疗有效率、白细胞介素(IL)-10、高敏C反应蛋白(hs-CRP)及脑梗死面积。结果:治疗后,实验组患者GCS评分明显高于常规组和治疗前[(12.7±7.8)分比(9.6±5.4)、(5.1±2.5)分],差异有统计学意义(均P<0.05)。实验组患者转为清醒的时间明显短于常规组[(3.0±1.3)d比(5.1±2.2)d],差异有统计学意义(P<0.05)。实验组患者的临床有效率明显高于常规组[70.0%(56/80)比60.0%(48/80)],差异有统计学意义(P<0.05)。治疗后,实验组IL-10高于常规组[(5.5±1.1)mmol/L比(2.6±0.4)mmol/L],hs-CRP低于常规组[(1.2±0.4)ms/L比(3.8±1.4)ms/L],梗死面积小于常规组[(1.8±0.2)cm^2比(2.6±0.7)cm^2],差异有统计学意义(均P<0.05)。结论:rh EPO联合纳洛酮治疗与单纯应用纳洛酮比较可进一步改善重型颅脑损伤昏迷患者的临床效果及预后。

Objective： To study the clinical effect of recombinant human erythropoietin combined with naloxone on coma patients post severe craniocerebral trauma. Methods： A total of 160 consecutive comas patients of severe cranioccrebral trauma with Glasgow coma scale （GCS） score of 3-8 in Foshan Emergency Medical Center from June 2012 to July 2015 were enrolled and randomly divided into the observation group （80 cases） and the control group （80 cases）. Conventional treatments including life care, hemostasis, lowering intracranial pressure and anti infection were given in both groups. In addition, the patients in control group received intravenous injection of naloxone and the patients in observation group received erythropoietin （subcutaneous injection） combined with naloxone. The GCS score, waking-up time, effective rate, levels of interleukin （IL）-10, high sensitivity C reactive protein （hs-CRP） and area of cerebral infarction were compared between the two groups before and after treatment. Results： The GCS score of observation group after treatment was significantly increased compared with that before treatment [（12.7± 7.8） scores vs （5.1 ± 2.5） scores]; it was also higher than that of the control group [（9.6± 5.4） scores,P 〈 0.05]. The waking-up time of observation group was significantly longer than that of the control group [（3.0± 1.3）d vs （5.1± 2.2）d], and the total efficacy rate of observation group was significantly higher than that of the control group [70.0%（56/80） vs 60.0% （48/80）] （both P〈0.05）. After treatment, the IL-10 level of observation group was higher, the hs-CRP level was lower and the infarction area was smaller than those of the control group [IL-10：（5.5± 1.1） mmol/L vs （2.6± 0.4） mmol/L,hs-CRP： （1.2 ± 0.4）mg/L vs （3,8 _± 1.4）mg/L, infarction area： （1.8 ± 0.2）cm^2 vs （2.6 ± 0.7）cm^2] （all P 〈0.05）. Conclusions： Erythropoietin combined with naloxone could further improve the clinical effect and prognosis of coma patients post severe craniocerebral trauma compared with single application ofnaloxone.