参附注射液对重型颅脑损伤患者脑血流动力学及颅内压的影响.DOCVIP

临床医学论文-参附注射液对重型颅脑损伤患者脑血流动力学及颅内压的影响 【摘要】? 目的 观察参附注射液对重型颅脑损伤患者脑血流动力学及颅内压的影响。方法 将86例重型脑损伤患者随机分为对照组与治疗组各43例。对照组采用常规治疗，治疗组采用常规治疗加参附注射液静滴。治疗过程中应用经颅多普勒(TCD)监测脑血流动力学及应用颅内压监护仪监测颅内压。结果 治疗组GCS评分在参附注射液治疗5 d后不同记录时间点均显著高于对照组(P0.05和P0.01)；治疗组脑血流动力学Vs、Vm、PI值在治疗3 d后与对照组相比明显改善(P0.01和P0.001)；治疗组在3 d后平均颅内压明显低于对照组(P0.001)。结论 参附注射液可改善重症颅脑损伤引起的脑血流动力学紊乱，降低颅内压，改善患者预后。 【关键词】? 参附注射液 重型颅脑损伤 脑血流动力学 颅内压 ??? 【Abstract】? Objective? To observe the effect of Shenfu injection on cerebral haemodynamics and intracranial pressure of patients with severe craniocerebral injury. Methods?86 cases with severe craniocerebral injury were 压divided randomly into two groups. All the cases were given regular drugs, in addition, the treatment group received intravenously Shenfu injection.Cerebral haemodynamics was measured with TCD, and ICP was monitored by ICP monitor. Results?GCS scale was obviously increased in the treatment group after 5d of treatment(P0.05 or P0.01).Vs, Vm and PI in cerebral haemodynamics were significantly improved in the treatment group after 3d of treatment(P0.01 or P0.001), and average ICP in the treatment group was lower after 3d of treatment(P0.001).Conclusion?Shenfu injection can improve cerebral haemodynamics, decrease ICP and improve the prognosis of patients with severe craniocerebral injury. ??? 【Key words】? Shenfu injection;? Severe craniocerebral injury; Cerebral haemodynamics; ICP ??? 在重型颅脑损伤过程中，早期以脑水肿、颅内压增高为主要改变，而后期以脑血管痉挛、脑缺血等继发性脑损害最为突出。由于颅脑损伤的原发损伤不可逆转，因此，防治继发性脑损伤是重型颅脑损伤治疗的重要方向，控制颅内压升高和改善脑循环障碍是治疗关键［1］。目前研究表明早期应用参附注射液可有效治疗重型颅脑损伤［2］，然而其对颅脑损伤患者血流动力学及颅内压的影响研究较少。本研究应用参附注射液对重型颅脑损伤患者进行治疗，观察其对脑血流动力学及颅内压的影响，为参附注射液应用于颅脑损伤治疗提供科学依据。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 2006年1月～2008年1月入院的重型颅脑损伤患者86例，格拉斯哥昏迷评分(GCS)3～8分，经神经科系统检查、头颅CT等明确诊断，且无心、肝、肺、肾等脏器的严重合并损伤。按入院先后随机分为治疗组和对照组各43例。治疗组中男30例，女13例，年龄18～67岁，平均(32.8±12.6)岁；GCS评分平均(5.2±2.6)分；交通事故伤29例，坠落伤11例，打击伤3例；硬膜外血肿17例，硬膜下血肿14例，脑内血肿7例，脑挫裂伤5例。对照组中男28例，女15例，年龄17～65岁，平均(33.6±11.9)岁；GCS评分平均(5.4±2.8)分；交通事故伤31例，坠落伤10例，打击伤2例；硬膜外血肿19例，硬膜下血肿12例，脑内血肿12例。两组间性别、年龄及病情