盐酸纳美芬在儿童心肺复苏后神经系统保护作用的临床研究

Protective Effects of Nalmephen Hydrochloride on Nervous System after Cardiopulmonary Resuscitation in Children

目的:研究心肺复苏后患儿应用盐酸纳美芬血清中强啡肽的变化,评估盐酸纳美芬对儿童心肺复苏后神经系统损伤的保护作用及其不良反应。方法:选取心肺复苏后患儿40例,随机数表法分为治疗组和对照组各20例。对照组采用降颅压、抗感染、营养神经等常规治疗;治疗组在常规治疗的基础上加用盐酸纳美芬治疗。所有患儿在治疗前及治疗后第1、3、7天测定血清强啡肽的含量,同时记录患儿心率、呼吸变化及药物不良反应发生情况,比较两组患儿1个月后的格拉斯哥昏迷评分(GCS)。结果:治疗前治疗组患儿血清强啡肽含量为(915.45±195.63)pg/mL,对照组患儿血清强啡肽含量为(962.32±220.71)pg/mL,两组比较差异无统计学意义;治疗后两组患儿血清强啡肽含量均呈下降趋势,治疗后第1天治疗组血清强啡肽含量为(807.06±155.90)pg/mL,对照组血清强啡肽含量为(1105.04±224.79)pg/mL,差异有统计学意义(P<0.01),治疗后第3、7天治疗组血清强啡肽含量与对照组比较差异无统计学意义(P>0.05)。治疗组呼吸异常、心率异常发生率均较对照组低,且治疗组心率异常的发生率低于对照组(P<0.05);两组患儿治疗过程中药物不良反应发生率比较差异无统计学意义(P>0.05)。治疗组临床症状、体征、脑部影像学及脑电图改善情况均优于对照组。结论:盐酸纳美芬可降低心肺复苏后患儿血清强啡肽水平,减轻继发性颅脑损伤,对神经系统具有一定的保护作用,同时可降低心肺复苏后患儿心率异常发生率。

Objective:To study the variation of serum dynorphin after the treatment of nalmephen hydrochloride in children after cardiopulmonary resuscitation,and to evaluate the protective effects of nalmephen hydrochloride on neurological injury after cardiopulmonary resuscitation and its adverse drug reactions.Methods:Forty children with cardiopulmonary resuscitation were extracted to be divided into the treatment group and the control group via the random number table,with 20 cases in each group.The control group received conventional treatment such as intracranial pressure reducing,anti-infection and nerve nutrition;the treatment group was treated with nalmefene hydrochloride on the basis of conventional treatment.Serum level of dynorphin was measured in all children before treatment and on the 1;,3;and 7;d after treatment,and changes in heart rate,respiration and adverse drug reactions were recorded.Glasgow Coma scale(GCS)was compared between two groups after treatment of 1 month.Results:Before treatment,the serum level of dynorphin in the treatment group was(915.45±195.63)pg/mL,and the serum level of dynorphin in the control group was(962.32±220.71)pg/mL,with no statistically significant difference between two groups.After treatment,the serum level of dynorphin in two groups showed the downward trend.On the 1;d after treatment,the serum level of dynorphin in the treatment group was(807.06±155.90)pg/mL,and the serum level of dynorphin in the control group was(1,105.04±224.79)pg/mL,the difference was statistically significant(P<0.01).There was no significant difference in the serum level of dynorphin between two groups on the 3;and 7;d after treatment(P>0.05).The incidence of respiratory abnormalities and heart rate abnormalities were lower in the treatment group than in the control group,and the incidence of heart rate abnormalities was lower in the treatment group than in the control group(P<0.05).There was no significant difference in the incidence of adverse drug reactions between two groups(P>0.05).The improvements of clinical symptoms,signs,brain imaging and EEG in the treatment group were better than those in the control group.Conclusion:Nalmephen hydrochloride can reduce the serum level of dynorphin in children after cardiopulmonary resuscitation,relieve the secondary craniocerebral injury,protect the nervous system,and reduce the incidence of abnormal heart rate in children after cardiopulmonary resuscitation.