丹参注射液联合乌司他丁对重型颅脑损伤患者的脑保护作用及对炎症反应的影响

Effect of Danshen injection combined with ulinastatin on the brain protection and inflammatory reaction in patients with severe traumatic brain injury

目的 观察丹参注射液联合乌司他丁对重型颅脑损伤患者的脑保护作用及对炎症反应的影响。方法 选取2014年3月~2016年5月杭州市中医院ICU收治的重型颅脑损伤患者83例,随机分为观察组（43例）和对照组（40例）。对照组在常规治疗的基础上给予乌司他丁,观察组在对照组的基础上给予丹参注射液。治疗10 d,观察2组脑血流参数（Qmean、Zc、DR）及血清神经功能相关指标（β-EP、Dyn Al-13、NSE）、炎症因子（IL-1、IL-6、TNF-α、CRP）水平的变化。结果 2组脑血流参数水平比较Qmean、Zc、DR水平比较差异有统计学意义（F分组=6.126、5.024、5.621,P〈0.05）,2组Qmean随着时间的延长逐渐升高而Zc、DR随着时间的延长逐渐降低（F时间=10.146、9.247、9.381,P〈0.05）,观察组变化幅度大于对照组（F交互=5.357、4.257、4.813,P〈0.05）;2组β-EP、Dyn Al-13、NSE水平比较差异有统计学意义（F分组=5.827、6.294、6.731,P〈0.05）,2组β-EP、Dyn Al-13、NSE随着时间的延长逐渐下降（F时间=12.613、11.746、9.842,P〈0.05）,观察组下降幅度大于对照组（F交互=6.353、7.251、4.284,P〈0.05）;2组IL-1、IL-6、TNF-α、CRP水平比较差异有统计学意义（F分组=4.284、5.162、6.174、4.291,P〈0.05）,2组IL-1、IL-6、TNF-α、CRP随着时间的延长呈先升高后下降趋势（F时间=9.163、10.357、13.457、12.434,P〈0.05）,观察组下降幅度大于对照组（F交互=4.255、5.242、8.530、7.847,P〈0.05）。结论 丹参注射液联合乌司他丁治疗重型颅脑损伤能更好的保护脑功能及抑制炎症反应,优于单用乌司他丁。

Objective To observe the effect of Danshen injection combined with ulinastatin on the brain protection and inflammatory reaction in patients with Severe traumatic brain injury. Methods 83 cases of patient with Severe traumatic brain injury were randomly divided into the observation group（43 cases） and the control group（40 cases）. The control group was given ulinastatin based on conventional treatment, and the observation group was given Danshen injection and ulinastatin based on the control group. For 10 days,the differences of hemodynamic parameters （ Qmean、 Zc、 DR） and serum nerve function indexes（ （3-EP、 DynAl-13、 N S E ） ,inflammatory factors （ IL-1, IL-6, TNF-a, CRP） between the two groups were be compared. Results ①Comparison of hemodynamic parameters There was significantly difference of Qmean、 Zc、 DR in these two groups （ F group = 6. 126, 5. 0 2 4,5. 621 ,P 〈0. 05） , Qmean was showed a rising trend over time and Zc-,DR were showed a declining trend over time （Ftime = 10. 146,9. 247 ,9. 381, P 〈 0. 05） , the changed amplitude in observation group was higher than the control group （^interaction = 5. 357 ,4. 257 ,4. 813 , P 〈 0. 05） ; Comparison of nerve unction indexes There was significantly difference of p-EP^DynAl-13 -,NSE in these two groups （^group = 5. 827 ,6. 294,6. 731, P 〈 0. 05） , they was all showed a reducing trend over time （ Ftime = 12. 613,11. 746,9. 842, P 〈 0. 05 ） , the declined amplitude in observation group was higher than the control group （ Finteizction = 6. 353 ,7. 251,4. 284 ,P 〈 0. 05） ; Comparison of inflammatory factors There was significantly difference of IL-1, IL-6, TNF-a, CRP in hese two groups （^group =4. 284,5. 162,6. 174,4. 291, P 〈0. 05） , they was all showed a rising then reducing trend over time （Ftime = 9. 163,10. 357 , 13. 457,12. 434, P 〈 0. 05） , the changed amplitude in observation group was higher than the control group （^interaction =4. 255 ,5. 242,8. 530,7. 847 , P〈0. 05 ） . Conclusion Danshen injection combined with ulinastatin has more obviously function of protecting the cerebralfunction and suppressing inflammation in the treatment of Severe traumatic brain injury compared with ulinastatin alone.