隆德概念治疗重型颅脑损伤的临床疗效及其对脑脊液乳酸含量的影响

Clinical Efficacy of Lunde Concept in Treating Severe Craniocerebral Injury and the Impact on Cerebrospinal Fluid Lactic Acid Content

目的探讨隆德概念治疗重型颅脑损的临床疗效及其对脑脊液乳酸(CSF-LA)含量的影响。方法选取2015-2017年柳州市人民医院ICU收治的重型颅脑损伤患者60例,采用随机数字表分为对照组和治疗组,每组30例。对照组患者给予常规治疗,治疗组患者在常规治疗基础上采用隆德概念治疗;两组患者均连续治疗2周。比较两组患者治疗前及治疗24 h、48 h、72 h、7 d、14 d CSF-LA含量、颅内压(ICP),治疗前后格拉斯哥昏迷量表(GCS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,ICU入住时间,治疗期间不良反应发生情况及随访3个月预后。结果(1)时间与方法在CSF-LA含量、ICP上存在交互作用(P<0.05);时间、方法在CSF-LA含量、ICP上主效应显著(P<0.05)。治疗组患者治疗48 h、72 h、7 d CSF-LA含量、ICP低于对照组(P<0.05)。(2)两组患者治疗前GCS评分、APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗后治疗组患者GCS评分高于对照组,APACHEⅡ评分低于对照组(P<0.05)。(3)治疗组患者ICU入住时间短于对照组(P<0.05)。(4)治疗期间两组患者无一例发生不良反应。(5)随访3个月治疗组患者预后优于对照组(P<0.05)。结论隆德概念可有效降低重型颅脑损伤患者CSF-LA含量、ICP,减轻继发性脑缺血缺氧,缩短ICU入住时间,有利于改善患者预后。

Objective To investigate the clinical efficacy of Lunde concept in treating severe craniocerebral injury and the impact on cerebrospinal fluid lactic acid(CSF-LA) content. Methods From 2015 to 2017,a total of 60 patients with severe craniocerebral injury were selected in ICU,the People’s Hospital of Liuzhou,and they were divided into control group and treatment group according to random number table method,with 30 cases in each group. Patients in control group received conventional treatment,while patients in treatment group received Lund concept based on conventional treatment;both groups continuously treated for 2 weeks. CSF-LA content and intracranial pressure(ICP)before treatment,24 hours,48 hours,72 hours,7 days and 14 days after treatment,Glasgow Coma Scale(GCS)score and APACHE Ⅱ score before and after treatment,ICU stays,incidence of adverse reactions during treatment and prognosis 3 months after follow-up were compared between the two groups. Results(1)There was statistically significant interaction between time and method in CSF-LA content and ICP(P<0.05);main effects of time and method were statistically significant in CSF-LA content and ICP(P<0.05).CSF-LA content and ICP in treatment group were statistically significantly lower than those in control group 48 hours,72 hours and 7 days after treatment(P<0.05).(2)No statistically significant difference of GCS score or APACHE Ⅱ score was found between the two groups before treatment(P>0.05);after treatment,GCS score in treatment group was statistically significantly higher than that in control group,while APACHE Ⅱ score in treatment group was statistically significantly lower than that in control group(P<0.05).(3)ICU stays in treatment group was statistically significantly shorter than that in control group(P<0.05).(4)No one in the two groups occurred any adverse reactions during treatment.(5)Prognosis in treatment group was statistically significantly better than that in control group 3 months after follow-up(P<0.05). Conclusion Lund concept can effectively reduce the CSF-LA content and ICP,relieve the secondary ischemic anoxia injury in patients with severe craniocerebral injury,reduce ICU check-in time,which is helpful to improve the prognosis.