大剂量地塞米松在防治重型颅脑伤术后脑水肿的疗效评价

Effect of Megadose Dexamethasone on Delayed Traumatic Brain Edema Postoperatively

选择Glasgow昏迷评分8分以下、伤后6小时内入院的颅脑伤病人83例,随机分为应用地塞米松5mg/kg体重的大剂量组(51例)和0.5mg/kg的常规剂量组(32例)。发现大剂量组存活率为80.39%,小剂量组为43.75%;存活者恢复到清醒(GCS 15分)的天数:大剂量组6.18±2.68天、常规量组14.71±12.75天;P<0.01;大剂量组的颅内压在术后第5天降至1.77±0.7kPa(183.44±74.09mmH_2O),常规量组则在第10天才降到1.8±0.78kPa(185.00±81.67mmH_2O);术后第5天和30天CT复查,脑水肿程度较轻,脑软化灶很少;挫伤周围非功能区组织学检查显示,大剂量组的水肿程度、血脑屏障和细胞内结构的变化明显轻于常规量组。结果表明,应用大剂量地塞米松防治重型颅脑伤后的继发性脑水肿,疗效是确切的。

Eighty three head injured patients with GCS (Glasgow Coma Scale) under 8 ponints, who were admitted within 6 hours post-traumaticly, were selected into this study, in which the cases were randmizingly divieded into high-dose dexamethasone group (HD) and common-dose group (CD). The patients in HD group (n=51) recerived injection of 5mg dexamethasone per kg body weight and those in CD group (n=32) received 0.5mg/kg. Data were shown the survive rate in HD group was 80. 39% and 43.75% in the CD. Among the surviver, it took 6.18±2.68 days for the subjects recovering from coma to consciouseness(GCS 15) in the HD and 14.71±12.75 days in the CD (P<0.01). Intracraniai pressure (ICP) was also decreased more quickly in the HD than that in CD group. ICP was reduced to 183.44±74.09 mmH_2O (N=33) at 5 days postoperatively, in the HD and to 185.00±81.67mmH_2o (n=6) at 10 days in another. In CT scanning at 5 and 30 days after operation, the brain edema was found much minor The brain edema in the HD. In tissue around contussion area of the HD group lighter brain edema, less changed of blood-brain barrier and cell microconstructure by light and electron mecroecopy. The resuits bear testimony to high-dose dexamethsasone effectively preventing delayed brain edema from sever head trauma.