脑电双频指数评价2种剂量纳洛酮在重度颅脑损伤患者中的治疗价值
The evaluation of therapeutic value of two different doses of naloxone in patients with severe craniocerebral injury using bispectral index
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摘要: 目的：观察2种不同剂量纳洛酮对重度颅脑损伤患者的脑电双频指数（BIS）的影响，探讨2种不同剂量纳洛酮的临床疗效，以及用BIS评估重度颅脑损伤预后的可行性。方法：收集55例成人重度颅脑损伤患者，按照入院先后时间顺序随机分为对照组（18例），小剂量纳洛酮组（A组，18例）和大剂量纳洛酮组（B组，19例），对照组给予常规治疗，在常规治疗基础上，A组给予纳洛酮0.1 mg·kg-1·d-1，B组给予纳洛酮0.4 mg·kg-1·d-1，治疗14 d，3组在此期间持续监测记录BIS值；在治疗1个月末对患者进行格拉斯哥预后评分（GOS）。结果：3组患者入院第1天的BIS值差异无统计学意义（P>0.05），A组和B组患者入院治疗第14天时BIS值均较入院第1天显著升高（P<0.01）。B组患者入院第14天BIS值升高程度均明显高于对照组和A组（P<0.01）。A组和B组治疗1个月末GOS评分均高于对照组（P<0.01），且B组患者治疗1个月末GOS评分明显高于A组（P<0.01）。3组患者入院第14天BIS值与GOS评分呈明显正相关关系（P<0.01）。3组患者治疗1个月末的病死率差异无统计学意义（P>0.05）。结论：早期大剂量纳洛酮可保护重度颅脑损伤患者的神经功能，但不能降低病死率，BIS对脑损伤程度及预后评估效果良好。Abstract: Objective: To observe the effects of two different doses of naloxone on Bispectral index(BIS) in patients with severe craniocerebral injury,explore the clinical curative effects of different doses of naloxone,and evaluate the feasibility of the BIS in judging the prognosis of patients with severe craniocerebral injury.Methods: Fifty-five adult patients with severe craniocerebral injury were divided into the control group(18 cases),low-dose naloxone group(group A,18 cases) and high-dose naloxone group(group B,19 cases) according to the admission time.The control group were treated with routine method.The groups A and B were treated with 0.1 mg·kg-1·d-1 and 0.4 mg·kg-1·d-1 naloxone based on the routine method for 14 days.The BIS value in groups A and B were recorded during treatment,and the scores of Glasgow Outcome Scale(GOS) in groups A and B were measured after 1 month of treatment.Results: The differences of the BIS value between three groups were not statistically significant in the first day of admission(P>0.05),and the BIS value in groups A and B after 14 days of admission increased significantly compared with that in the first day of admission(P<0.01).The increasing degree of BIS value after 14 days of admission in group B was significantly higher than that in control group and group A(P<0.01).The scores of GOS in groups A and B were significantly higher than that in control group(P<0.01),and the score of GOS in group B was significantly higher than that in group A after 1 month of admission(P<0.01).The BIS value of patient was significantly positive correlation with the GOS score after 14 days of admission(P<0.01).The differences of the mortality after 1 month of treatment between 3 groups were not statistically significant(P>0.05).Conclusions: The treatment of the severe craniocerebral injury with early large dose naloxone can improve the nerve function,but which can not reduce the mortality of patients.The effect of BIS in evaluating the degree of brain damage and prognosis is good.
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Key words:
- craniocerebral injury /
- bispectral index /
- naloxone
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