早期醒脑静联合血管内控制性降温对重型颅脑损伤患者脑脊液乳酸水平及预后的影响

Effect of Intravenous Infusion of Xingnaojing Injection and Intravascular Controlled Cooling on Lactic Acid in Cerebrospinal Fluid and Prognosis of Patients with Acute Severe Brain Injury

目的:观察早期醒脑静注射液联合血管内控制性降温对重型颅脑损伤患者的预后及脑脊液乳酸水平的影响。方法:选择重型颅脑损伤患者66例,按不同辅助治疗方式随机分为治疗组(醒脑静+血管内控制性降温)31例、对照组(醒脑静+局部亚低温)35例。比较两组患者早期脑脊液乳酸含量的变化,同时采用斯堪地那维亚卒中量表(Scandinavian Stroke Scale,SSS)评分法评估两组患者治疗前,治疗后7、14和30 d的临床疗效。结果:治疗后7、14 d,两组SSS评分较治疗前均有明显升高,但是两组比较差异无统计学意义(P>0.05);治疗后30 d,治疗组SSS评分升高更为明显,两组比较差异有统计学意义(P=0.008<0.01)。治疗后1、2、3、4和5 d,两组脑脊液乳酸含量均出现明显下降,但是两组比较差异无统计学意义(P>0.05);治疗后6 d和7 d,与对照组比较,治疗组脑脊液乳酸含量下降更为明显,差异有统计学意义(P=0.000<0.01;P=0.000<0.01)。结论:醒脑静联合早期血管内控制性降温能显著降低重型颅脑损伤患者脑脊液乳酸水平、改善预后、促进患者神经功能的恢复,远期获益显著。

Objective ：To observe the effect of intravenous infusion of xingnaojing injection and intravascular controlled cooling on prognosis and cerebrospinal fluid lactic acid level of patients with acute severe brain injury. Methods ：66 cases with acute severe brain injury were randomly divided into the treatment group （31 cases, xingnaojing injection＋intravascular controlled cooling） and control group （35 cases, xingnaojing injection＋local mild hypothermia therapy） according to the different strategy. The cerebrospinal fluid lactic acid level was compared between the two groups. Clinical outcomes were evaluated by Scandinavian Stroke Scale （SSS） at 7 d, 14 d and 30 d after treatment. Results ：SSS score in the two groups was markedly increased at 7 d and 14 d after treatment, but there was no statistically significant between the two groups （ P〉 0.05）. SSS score in the treatment group was also markedly increased than control group at 30 d after treatment, and the difference was statistically significant（ P= 0.008〈0.01）. The cerebrospinal fluid lactic acid level were markedly decreased in the two groups at 1d, 2d, 3d, 4d and 5d after treatment, but there was no significant difference between the two groups （ P〉 0.05）. However, the cerebrospinal fluid lactic acid level in the treatment group were markedly decreased in comparison with control group at 6 d and 7 d after treatment, and the difference was statistically significant（ P= 0.000〈0.01, P= 0.000〈0.01）. Conclusion ：Combined intravenous infusion of xingnaojing injection and intravascular controlled cooling has a cumulative effect that enhances the overall outcome of treatment for severe brain injury at early stage. It was beneficial to the cerebrospinal fluid lactic acid decreasing and long-term neurofunctional rehabilitation.