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目的:探讨重组人促红细胞生成素(recombinant human erythropoietin,rh EPO)联合纳洛酮治疗重型颅脑损伤昏迷患者的临床效果。方法:选取2012年6月至2015年7月于佛山急诊抢救中心接受治疗的重型颅脑损伤昏迷患者160例,格拉斯哥昏迷量表(GCS)评分3~8分,将患者完全随机分为实验组和常规组,各80例。两组患者均给予生命监护、止血、激素以及局部亚低温等常规治疗,常规组静脉/肌内注射纳洛酮(0.01-0.02 ms/kg,若给药后无反应,3-5 min后重复1次,直至患者苏醒),后续给予纳洛酮2mg加入5%葡萄糖或0.9%氯化钠注射液中持续静脉滴注,给药时间为45-90 min;实验组在常规组基础上于治疗第1、4、7、10、13天皮下注射rh EPO 7 500 IU/次,持续2周。比较两组患者治疗前后GCS评分、转为清醒的时间、治疗有效率、白细胞介素(IL)-10、高敏C反应蛋白(hs-CRP)及脑梗死面积。结果:治疗后,实验组患者GCS评分明显高于常规组和治疗前[(12.7±7.8)分比(9.6±5.4)、(5.1±2.5)分],差异有统计学意义(均P<0.05)。实验组患者转为清醒的时间明显短于常规组[(3.0±1.3)d比(5.1±2.2)d],差异有统计学意义(P<0.05)。实验组患者的临床有效率明显高于常规组[70.0%(56/80)比60.0%(48/80)],差异有统计学意义(P<0.05)。治疗后,实验组IL-10高于常规组[(5.5±1.1)mmol/L比(2.6±0.4)mmol/L],hs-CRP低于常规组[(1.2±0.4)ms/L比(3.8±1.4)ms/L],梗死面积小于常规组[(1.8±0.2)cm~2比(2.6±0.7)cm~2],差异有统计学意义(均P<0.05)。结论:rh EPO联合纳洛酮治疗与单纯应用纳洛酮比较可进一步改善重型颅脑损伤昏迷患者的临床效果及预后。
Objective: To investigate the clinical effect of recombinant human erythropoietin (rh EPO) combined with naloxone on patients with coma after severe craniocerebral injury. Methods: One hundred and sixty patients with severe traumatic brain injury coma who were treated in Foshan emergency center from June 2012 to July 2015 were selected. The Glasgow coma scale (GCS) score was 3 to 8, and the patients were randomly divided into experimental group And the conventional group, each 80 cases. Patients in both groups were given routine monitoring such as life monitoring, hemostasis, hormones and local mild hypothermia. Conventional group received naloxone (0.01-0.02 ms / kg intravenously / intramuscularly, repeated after 3-5 min if there was no response after administration 1 times, until the patient awake), followed by naloxone 2mg added 5% glucose or 0.9% sodium chloride injection continuous intravenous infusion, the time for 45-90 min; experimental group on a routine basis in the treatment On the 1st, 4th, 7th, 10th and 13th days, rh EPO 7 500 IU / time was injected subcutaneously for 2 weeks. The GCS score, time to soberness, therapeutic efficiency, interleukin-10, hs-CRP, and infarct size were compared between the two groups before and after treatment. Results: After treatment, the GCS score of the experimental group was significantly higher than that of the conventional group and before treatment [(12.7 ± 7.8) vs (9.6 ± 5.4), (5.1 ± 2.5)], the difference was statistically significant (P <0.05 ). The time to awake in the experimental group was significantly shorter than that in the conventional group [(3.0 ± 1.3) d vs (5.1 ± 2.2) d], with significant difference (P <0.05). The clinical effective rate in the experimental group was significantly higher than that in the conventional group [70.0% (56/80) vs 60.0% (48/80)]. The difference was statistically significant (P <0.05). After treatment, the level of IL-10 in the experimental group was significantly lower than that in the conventional group [(5.5 +/- 1.1) mmol / L vs (2.6 +/- 0.4) mmol / L] 3.8 ± 1.4) ms / L]. The infarct size was smaller than that of the control group [(1.8 ± 0.2) cm 2 vs 2.6 ± 0.7 cm 2] (P 0. 05). Conclusion: The combination of rh EPO and naloxone can improve the clinical effect and prognosis of coma patients with severe traumatic brain injury.