摘要
目的：观察Lund概念联合安宫牛黄丸对重型颅脑损伤患者疗效和预后的影响。方法采用前瞻性病例对照研究方法，将49例重型颅脑损伤患者按所采取的治疗措施不同分为Lund概念联合安宫牛黄丸组（联合治疗组）25例及常规治疗对照组24例。两组患者均给予常规治疗，联合治疗组患者在常规治疗基础上入住重症加强治疗病房（ICU）后即开始留置胃管（颅底骨折患者经口留置胃管）鼻饲安宫牛黄丸，每次1丸，每日2次，连用15 d。观察两组治疗前后颅内压（ICP）、脑灌注压（CPP）、格拉斯哥昏迷评分（GCS）、大脑中动脉（MCA）平均血流速度，以及并发症发生率、临床疗效和预后。结果两组治疗前和治疗后1 d ICP、CPP、GCS评分、平均血流速度比较差异均无统计学意义；治疗后3d起联合治疗组上述指标的改善程度均明显优于对照组〔ICP（mmHg，1 mmHg＝0.133 kPa）：16.78±4.50比18.80±5.67，CPP（mmHg）：71.35±1.63比58.11±1.47， GCS评分（分）：9.53±0.38比8.23±0.44，平均血流速度（cm/s）：152.23±3.33比178.86±5.23，均P＜0.05〕。联合治疗组高热〔8.0%（2/25）比41.7%（10/24）〕、抽搐〔12.0%（3/25）比45.8%（11/24）〕、脑疝〔8.0%（2/25）比33.3%（8/24）〕的发生率均明显低于对照组（均P＜0.05），肾衰竭、电解质紊乱、肺部感染发生率亦低于对照组，但两组比较差异均无统计学意义（均P＞0.05）。联合治疗组良好率明显高于对照组〔72.0%（18/25）比33.3%（8/24），P＜0.05〕，病死率明显低于对照组〔8.0%（2/25）比33.3%（8/24），P＜0.05〕。结论 Lund概念联合安宫牛黄丸治疗重型颅脑损伤，可降低颅脑损伤后早期的ICP增高程度，减轻脑水肿的发生发展，提高CPP，改善脑缺血、缺氧，在控制高热、减少肢体抽搐、降低脑疝发生率，提高患者的生存质量，降低病死率及改善预后方面均有较�
Objective To observe the therapeutic effect and prognosis of patients with severe traumatic craniocerebral injury treated by Lund program combined with Angong Niuhuang pill. Methods A prospective study was conducted. Forty-nine patients with severe traumatic craniocerebral injury were divided into two groups：combined treatment group （25 cases） and control group （24 cases）. All the patients in the two groups received conventional therapy. Additionally, the combined treatment group was treated by the Lund program combined with Angong Niuhuang pill, the patients after admission into the intensive care unit （ICU）, indwelling of gastric tube was immediately given （the tube inserted and retained through mouth in cases with cranial base bone fracture）, one pill of Angong Niuhuang was fed nasally twice a day for consecutive 15 days. Before and after treatment, the intracranial pressure （ICP）, cerebral perfusion pressure （CPP）, Glasgow coma scale （GCS） score, the mean flow velocity of middle cerebral artery （MCA）, and the incidence of complication, clinical efficacy and prognosis in the two groups were observed. Results There were no statistically significant differences in the levels of ICP, CPP, GCS score and the average flow velocity of MCA before treatment and the first day after treatment between the two groups. Beginning from 3 days after treatment, the degrees of improvement in the above indexes in the combination treatment group became much better than those in the control group [ICP （mmHg, 1 mmHg=0.133 kPa）：16.78±4.50 vs. 18.80±5.67, CPP （mmHg）：71.35±1.63 vs. 58.11±1.47, GCS score：9.53±0.38 vs. 8.23±0.44, the mean blood flow velocity （cm/s）：152.23±3.33 vs. 178.86±5.23, all P〈0.05]. The incidences of complications such as hyperpyrexia [8.0%（2/25） vs. 41.7%（10/24）], hyperspasmia [12.0%（3/25） vs. 45.8%（11/24）] and cerebral hernia [8.0%（2/25） vs. 33.3%（8/24）] in the combined treatment group were significantly lower than those in t
出处
《中国中西医结合急救杂志》
CAS
北大核心
2015年第2期164-169,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省医药卫生科学基金（2007B173）
关键词
Lund概念
安宫牛黄丸
颅脑损伤
重型
疗效观察
Lund program
Angong Niuhuang pill
Severe traumatic craniocerebral injury
Clinical effect observation
