纳美芬联合高压氧对急性重型颅脑损伤血清S100β蛋白、缺氧诱导因子-1α、丙二醛及乳酸水平的影响

Effects of nalmefene combined with hyperbaric oxygen therapy on serum levels of S100β protein,hypoxia-inducible factor-1α,malondialdehyde and lactate in acute severe craniocerebral injury

目的观察急性重型颅脑损伤病人采用纳美芬联合高压氧对其血清S100β蛋白、缺氧诱导因子⁃1α(HIF⁃1α)、丙二醛(MDA)及乳酸水平的影响及疗效。方法采用随机数字表法将2015年2月至2018年2月在安阳市人民医院接受治疗的92例急性重型颅脑损伤病人分为对照组(46例)和观察组(46例)。对照组病人采用常规治疗联合高压氧疗法,观察组病人在对照组基础上增加纳美芬治疗(纳美芬0.4~0.6 mg加入250 mL生理盐水中静脉注射,1次/天)。两组均持续治疗4周。评估两组临床疗效情况,并对比治疗前、治疗4周后格拉斯哥昏迷量表(GCS)评分,记录血清S100β蛋白、HIF⁃1α、MDA和乳酸水平差异。分析92例病人治疗前后上述血清学指标与GCS评分变化情况的相关性。结果两组病人治疗4周后与治疗前比较,GCS评分显著升高,而血清S100β蛋白、HIF⁃1α、MDA及乳酸水平均显著下降,且同期观察组较对照组变化更显著(均P<0.05)。治疗4周后观察组总有效率为89.13%,显著高于对照组的71.14%(P<0.05)。92例病人治疗前后血清S100β蛋白、HIF⁃1α、MDA及乳酸变化差值与GCS评分变化差值呈显著负相关性(r=-0.646、-0.704、-0.574、-0.725,P<0.05)。结论纳美芬联合高压氧能显著降低急性重型颅脑损伤病人的血清S100β蛋白、HIF⁃1α、MDA及乳酸水平,病人昏迷程度显著改善,较单一的高压氧疗组效果更为明显。

Objective To explore the effects and efficacy of nalmefene combined with hyperbaric oxygen therapy on serum levels of S100βprotein,hypoxia⁃inducible factor⁃1α(HIF⁃1α),malondialdehyde(MDA)and lactate in patients with acute severe cranio⁃cerebral injury.Methods 92 cases of patients with acute severe craniocerebral injury treated in Anyang People’s Hospital from February 2015 to February 2018 were divided into control group(46 cases)and observation group(46 cases)according to the ran⁃dom number table method.Control group was given conventional therapy combined with hyperbaric oxygen therapy,and observation group was given intravenously nalmefene on the basis of control group(0.4~0.6 m of nalmefene was added to 250 mL of normal sa⁃line for intravenous injection,once a day),and the two groups were continuously treated for 4 weeks.The clinical efficacy was evalu⁃ated in the two groups.The Glasgow Coma Scale(GCS)score was compared before treatment and after 4 w of treatment.The differ⁃ences of serum S100βprotein,HIF⁃1α,MDA and lactate were recorded.The correlation between above serological indicators and changes of GCS score before and after treatment was analyzed among the 92 patients.Results After 4 w of treatment,the GCS score in the two groups was significantly increased compared with that before treatment while the levels of serum S100βprotein,HIF⁃1α,MDA and lactate were significantly decreased,and the changes in observation group were more significant than those in control group(all P<0.05).After 4 w of treatment,the total effective rate in observation group was significantly higher than that in control group(89.13%vs.71.14%)(P<0.05).The differences of serum S100βprotein,HIF⁃1α,MDA and lactate before and after treatment among 92 patients were significantly negatively correlated with difference of GCS score(r=-0.646,-0.704,-0.574,-0.725,P<0.05).Conclusion Nalmefene combined with hyperbaric oxygen therapy can significantly reduce serum levels of S100βprotein,HIF⁃1α,MDA and lactate in patients with acute severe craniocerebral injury,and it has significantly improved coma degree of patients,and it has more obvious effects than the single hyperbaric oxygen therapy group.