摘要
目的探究依达拉奉辅助脑苷肌肽治疗重症颅脑损伤患者的作用效果以及与神经胶质纤维酸性蛋白(glial fiber acidic protein, GFAP)、泛素羧基末端水解酶-L1(ubiquitin carboxyl terminal-L1, UCH-L1)的影响。方法纳入苏州市相城人民医院于2016年1月至2017年12月期间收治的123例重症颅脑损伤患者。根据随机数字表法分为观察组和对照组,其中观察组61例,对照组62例。对照组给予脑苷肌肽治疗,观察组在对照组基础上给予依达拉奉治疗。比较两组患者的临床疗效,同时监测治疗前后血清丙二醇(malonaldehyde, MDA)、超氧化物歧化酶(superoxide dismutase, SOD)、髓过氧化物酶(myeloperoxidase, MPO)、基质金属蛋白酶-9(matrix metalloproteinases, MMP-9)、GFAP、UCH-L1水平及治疗过程中不良反应发生率。结果治疗后两组APACHEⅡ评分均降低(t=15.88,P=0.008;t=25.17,P=0.003),且观察组低于对照组,差异有统计学意义(t=15.95,P=0.013);治疗后两组日常生活能力(ADL)评分均升高(t=5.58,P=0.025;t=19.13,P=0.008),且观察组高于对照组,差异有统计学意义(t=11.24,P=0.012);治疗后两组MDA、SOD、MPO均升高,且观察组高于对照组,差异有统计学意义(t=11.41,P=0.024;t=2.03,P=0.22;t=7.16,P=0.038);治疗后两组MMP-9均下降,且观察组低于对照组,差异有统计学意义(t=16.25,P=0.012);治疗后两组GFAP(t=31.79,P=0.016;t=53.83,P=0.011)、UCH-L1(t=10.27,P=0.047;t=18.31,P=0.019)均下降,且观察组低于对照组,差异有统计学意义(t=43.90,P=0.014;t=15.31,P=0.035)。观察组不良反应总发生率为8.06%,对照组不良反应总发生率为9.83%,差异无统计学意义(χ^2=0.088,P=0.719)。结论依达拉奉辅助脑苷肌肽治疗重症颅脑损伤,可以有效保护神经细胞,改善神经功能,提高临床疗效,显著提高机体抗氧化能力,降低血清GFAP、UCH-L1水平,且安全性较好。
Objective To observe the influence of edaravin combined with cerebroside-kinin on the level of glial fiber acidic protein (GFAP) and ubiquitin carboxyl terminal-Ll (UCH-L1) in the treatment of severe craniocerebral injury. Methods From January 2016 to December 2017, a total of 123 patients with severe craniocerebral injury were selected in our hospital, and randomly(random number) assigned to the observation group (61 cases) and control group (62 cases). Patients in the control group were given cerebroside-kinin, and patients in the observation group were given cerebroside-kinin and edaravonc. The acute physiology and chronic health evaluation score (APACHE H ), activities of daily living (ADL) score, serum malonaldchyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), matrix metalloprotein 9 (MMP-9), GFAP and UCH-L1 before and after treatment were observed. The side effects were also recorded. Results The APACHE II score was significantly reduced in both groups after treatment (P=0.008;P=0.003), and was lower in the observation group than that in the control group (P=0.013). The ADL score of both groups increased after treatment (P=0.025;P=0.008), and was higher in the observation group than that in the control group (P=0.012). After treatment the levels of MDA, SOD and MPO in the observation group were significantly higher than those in the control group (P<0.05);the level of MMP-9 in the observation group was significantly lower than that in the control group (P=0.012);the levels of GFAP and UCH-L1 in the observation group were significantly higher than those in the control group (P=0.014;P=0.035). There was no significant difference of the total side effect incidence between the observation group and the control group (8.06% vs 9.83%, X^2=0.08& P=0.719). Conclusions The treatment by edaravone combined with cerebroside-kinin on severe craniocerebral injury may effectively protect the nerve cells, improve nerve function, clinical efficacy and the body's antioxidant capacity, reduce the serum levels of
作者
方理超
安堃
华燕琴
范诚
王晓旻
乔世刚
Fang Lichao;An Kun;Hua Yanqin;Fan Cheng;Wang Xiaomin;Qiao Shigang(Intensive Care Unit of Suzhou Xiangcheng People s Hospital, Suzhou 215131, China;Department ofAnesthesiology and Perioperative Medicine, Suzhou Science and Technology Town Hospital, Suzhou215153, China;Institue of Clinical Medicine, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215153, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2019年第3期319-323,共5页
Chinese Journal of Emergency Medicine
基金
苏州市“科教兴卫”青年计划项目(KJXW2015062)
苏州市相城区科技计划项目(XJ201657)
苏州市高新区医疗卫生科技计划重点项目(2016Z002)
江苏省青年医学人才项目(QNRC2016219).
