依达拉奉辅助亚低温对重型颅脑创伤的血清细胞因子及凝血功能的影响

Effects of Edaravone-assisted hypothermia on serum cytokines and coagulation function in severe traumatic brain injury

目的探讨依达拉奉辅助亚低温治疗对重型颅脑创伤(TBI)患者的凝血功能及神经生长因子(NGF)、降钙素基因相关肽(CGRP)的影响。方法选取沧州市中心医院神经外三科自2018年8月至2019年8月收治的62例重型TBI患者,按随机数字表法分为观察组(31例)和对照组(31例)。对照组患者给予亚低温治疗,观察组患者在亚低温治疗基础上给予依达拉奉辅助治疗14 d。比较2组患者的神经功能缺损评分和疗效,观察治疗前后患者的脑内凝血功能以及血清内NGF、CGRP含量的变化。结果观察组患者的临床治疗有效率显著高于对照组(P<0.05)。观察组患者采用依达拉奉辅助亚低温治疗后颅内水肿面积显著降低,大脑中动脉平均血流速度明显升高,美国国立卫生研究院卒中量表评分水平显著下降,巴塞尔指数评定量表评分和GCS评分显著增高,差异有统计学意义(P<0.05)。观察组患者采用依达拉奉辅助亚低温治疗后NGF、CGRP水平明显升高,血浆D-二聚体、纤维蛋白原、凝血酶原时间、凝血酶原时间国际标准比值、活化部分凝血活酶时间、凝血酶时间显著下降,抗凝血酶显著上升,差异均有统计学意义(P<0.05)。结论依达拉奉辅助亚低温治疗重型TBI的临床治疗效果较好,安全性较高,可有效恢复患者的凝血功能,促进NGF、CGRP表达。

Objective To explore the coagulation function and the effects of nerve growth factor(NGF)and calcitonin gene related peptide(CGRP)in edaravone-assisted mild hypothermia in the treatment of severe traumatic brain injury(TBI).Methods Sixty-two patients with severe TBI were selected from August 2018 to August 2019 in the Third Department of Neurology,Cangzhou Central Hospital.They were divided into observation group(31 cases)and control group(31 cases)according to the random number table.The control group was treated with mild hypothermia,and the observation group was treated with Edaravone-assisted hypothermia for 14 d.The neurological deficit score and curative effect of the two groups were compared.The blood coagulation function in brain and the content of NGF and CGRP in serum were observed before and after treatment.Results After the treatment of edaravone with mild hypothermia,the area of intracranial edema in the observation group was significantly reduced,the average blood flow velocity of middle cerebral artery was significantly increased,the National Institute of Health stroke scale score was significantly decreased,the Barthel score and GCS score were significantly increased(P<0.05).In the observation group,the levels of NGF and CGRP were significantly increased,the international standard ratio of plasma D-dimer,fibrinogen,prothrombin time,prothrombin time international normalized ratio,activated partial thromboplastin time and thrombin time were significantly decreased,and the anticoagulant enzyme was significantly increased(P<0.05).Conclusion Edaravone assisted with mild hypothermia in the treatment of severe TBI has better therapeutic effect and higher safety.It can effectively restore the coagulation function of patients and promote the expression of NGF and CGRP.