乌司他丁联合醒脑静注射液治疗重度颅脑损伤的临床研究
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篇名: 乌司他丁联合醒脑静注射液治疗重度颅脑损伤的临床研究
TITLE:
摘要: 目的:探讨乌司他丁注射液联合醒脑静注射液治疗重度颅脑损伤的临床效果及安全性。方法:选取2014年9月-2015年11月我院收治的重度颅脑损伤患者120例作为研究对象,按照治疗方案将患者分为乌司他丁组、醒脑静组和联合组,各40例。3组患者入院后均及时给予常规治疗。在常规治疗基础上,乌司他丁组患者给予乌司他丁注射液20万单位,ivgtt,bid;醒脑静组患者给予醒脑静注射液20 mL,ivgtt,qd;联合组患者给予乌司他丁注射液联合醒脑静注射液,用法同上(两药间隔1 h滴注)。3组患者均连续治疗14 d。观察3组患者治疗前后的血清炎症因子[C反应蛋白(CRP)、白细胞介素1(IL-1)、IL -6和肿瘤坏死因子α(TNF-α)]和颅脑损伤血清学指标[神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)和S100B蛋白(S100B)]水平、格拉斯哥昏迷(GCS)评分、治疗后的格拉斯哥预后(GOS)评分,并记录治疗过程中不良反应发生情况。结果:治疗前,3组患者血清炎症因子、颅脑损伤血清学指标和GCS评分比较,差异均无统计学意义(P>0.05)。治疗后,3组患者炎症因子水平均较治疗前显著降低,乌司他丁组显著低于醒脑静组,联合组显著低于两单药组,差异均有统计学意义(P<0.05);3组患者颅脑损伤血清学指标水平和GCS评分均显著改善,且联合组均显著优于两单药组,差异均有统计学意义(P<0.05),但乌司他丁组与醒脑静组比较,差异均无统计学意义(P>0.05)。治疗后6个月,联合组患者GOS评分[(4.17±0.81)分]显著优于乌司他丁组[(3.05±0.97)分]和醒脑静组[(2.97±0.89)分],差异均有统计学意义(P<0.05);但乌司他丁组与醒脑静组比较,差异无统计学意义(P>0.05)。治疗过程中,联合组患者的不良反应发生率(27.50%)显著低于乌司他丁组(50.00%)和醒脑静组(42.50%),差异均有统计学意义(P<0.05);但乌司他丁组与醒脑静组比较,差异无统计学意义(P>0.05)。结论:乌司他丁注射液联合醒脑静注射液可显著降低重度颅脑损伤患者血清炎症因子水平,减轻颅脑损伤,保护脑组织,改善患者近期预后,且安全性较高。
ABSTRACT: OBJECTIVE: To explore clinical efficacy and safety of Ulinastatin injection combined with Xingnaojing injection in the treament of severe craniocerebral injury (CCI). METHODS: A total of 120 severe CCI patients selected from our hospital during Sept. 2014-Nov. 2015 were divided into ulinastatin group, Xingnaojing group and combination group according to therapy plan, with 40 cases in each group. Three groups were given routine treatment timely after admission. On the basis of routine treatment,  Ulinastatin group additionally received Ulinastatin injection 200 000 U, ivgtt, bid; Xingnaojing group additionally received Xingnaojing injection 20 mL, ivgtt, qd; combination group additionally received Ulinastatin injection combined with Xingnaojing injection, same usage as above (with 1 h intervals). Three groups received therapy for consecutive 14 d. Serum inflammatory factors (CRP, IL-1, IL-6, TNF-α), serologic indexes of craniocerebral injury [neuron specific enolase (NSE), myelin basic protein (MBP), S100B protein (S100B)] and GCS scores before and after treatment as well as GOS scores after treatment were all observed in 3 groups. The occurrence of ADR was recorded during treatment. RESULTS: Before treatment, there was no statistical significance in serum inflammatory factors, serologic indexes of craniocerebral injury or GCS scores among 3 groups (P>0.05). Compared to before treatment, inflammatory factors of 3 groups were decreased significantly after treatment, the ulinastatin group was significantly lower than the Xingnaojing group, combination group was significantly lower than two single drug groups, with statistical significance (P<0.05). Levels of serologic indexes of craniocerebral injury and GCS scores of 3 groups were improved significantly, and the combination group was significantly better than the two single drug groups, with statistical significance (P<0.05). There was no statistical significance between ulinastatin group and Xingnaojing group (P>0.05). Six months after treatment, GOS score of combination group(4.17±0.81)was significantly better than those of ulinastatin group (3.05±0.97) and Xingnaojing group (2.97±0.89), with statistical significance (P<0.05); there was no statistical significance between ulinastatin group and Xingnaojing group (P>0.05). During treatment, the incidence of ADR in combination group (27.50%) was significantly lower than ulinastatin group (50.00%) and Xingnaojing group (42.50%), with statistical significance (P<0.05); there was no statistical significance between ulinastatin group and Xingnaojing group (P>0.05). CONCLUSIONS: Ulinastatin injection combined with Xingnaojing injection can significantly decrease serum inflammatory factor levels, relieve craniocerebral injury, protect cerebral tissue and improve short-term prognosis with good safety.
期刊: 2017年第28卷第29期
作者: 王华民,齐平建,于东,史进,董虹廷,付浩,李钦涛,陈洋
AUTHORS: WANG Huamin,QI Pingjian,YU Dong,SHI Jin,DONG Hongting,FU Hao,LI Qintao,CHEN Yang
关键字: 乌司他丁注射液;醒脑静注射液;重度颅脑损伤;炎症因子;颅脑损伤血清学指标
KEYWORDS: Ulinastatin injection; Xingnaojing injection; Severe craniocerebral injury; Inflammatory factor; Serlolgic index of craniocerebral injury
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