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目的观察依达拉奉联合辛伐他汀治疗创伤性脑损伤的临床效果。方法选择2012年6月—2013年9月乳山市人民医院收治的单纯创伤性脑损伤患者240例,随机分为观察组和对照组各120例。观察组入院后2 h内应用依达拉奉30 mg/次,2次/d,静脉滴注30 min,24 h内应用辛伐他汀片20 mg/次,每晚1次。对照组采用生理盐水100 ml/次,2次/d,静脉滴注。两组均连用14 d。计量资料采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组创伤性脑血管痉挛发生率为25.8%,对照组为49.2%,两组比较差异有统计学意义(P<0.05)。观察组治疗前后大脑中动脉血流速度(velocity in the midde cerebral artery,Vm MCA)分别为(141.36±12.15)、(87.28±13.47)cm/s,对照组分别为(143.17±12.69)、(134.20±10.57)cm/s;观察组治疗前后C反应蛋白(c-reactionprotein,CRP)分别为(12.36±4.01)、(7.71±2.55)mg/L,对照组分别为(13.04±3.75)、(12.71±3.24)mg/L;观察组治疗前后内皮素-1(endothein-1,ET-1)分别为(90.36±5.33)、(45.87±2.46)pg/ml,对照组分别为(93.81±4.79)、(82.17±4.91)pg/ml。观察组Vm MCA、CRP、ET-1治疗前后比较差异均有统计学意义(均P<0.05),治疗前两组Vm MCA、CRP、ET-1比较差异均无统计学意义(均P>0.05),治疗后两组比较差异均有统计学意义(均P<0.05)。观察组创伤性脑血管痉挛患者外伤性脑梗死发生率为25.8%,对照组发生率为54.2%,两组比较差异有统计学意义(P<0.05)。观察组预后良好率为75.0%,对照组为47.5%,两组比较差异有统计学意义(P<0.05)。结论依达拉奉注射液联合辛伐他汀能有效降低脑血管痉挛发生,降低Vm MCA、CRP、ET-1,有效缓解脑血管痉挛,降低炎症介质水平,减少缩血管物质产生,降低脑血管痉挛患者外伤性脑梗死的发生,改善预后。
Objective To observe the clinical effect of edaravone and simvastatin in the treatment of traumatic brain injury. Methods A total of 240 traumatic brain injury patients admitted to Rushan People’s Hospital from June 2012 to September 2013 were randomly divided into observation group (120 cases) and control group (120 cases). In the observation group, edaravone 30 mg / time, 2 times / d within 2 h after admission, intravenous infusion 30 min, simvastatin tablets 20 mg / time within 24 h, every night. The control group with saline 100 ml / time, 2 times / d, intravenous drip. Both groups were used for 14 days. Measurement data using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The incidence of traumatic cerebral vasospasm was 25.8% in the observation group and 49.2% in the control group, with significant difference between the two groups (P <0.05). The Vm MCA of the observation group before and after treatment were (141.36 ± 12.15) and (87.28 ± 13.47) cm / s, respectively, and those in the control group were (143.17 ± 12.69) and ± 10.57) cm / s. The levels of C-reactive protein in the observation group before and after treatment were (12.36 ± 4.01) and (7.71 ± 2.55) mg / L respectively, while those in the control group were (13.04 ± 3.75) and ± 3.24) mg / L, and the levels of endothelin-1 and ET-1 in the observation group were (90.36 ± 5.33) and (45.87 ± 2.46) pg / ml before and after treatment , (82.17 ± 4.91) pg / ml. There were significant differences in the levels of Vm MCA, CRP and ET-1 between the two groups before and after treatment (all P <0.05), and there was no significant difference in Vm MCA, CRP and ET-1 between the two groups before treatment ), After treatment there was significant difference between the two groups (all P <0.05). The incidence of traumatic cerebral infarction was 25.8% in the observation group and 54.2% in the control group. There was significant difference between the two groups (P <0.05). The good prognosis of the observation group was 75.0%, the control group was 47.5%, the difference between the two groups was statistically significant (P <0.05). Conclusion Edaravone and simvastatin can effectively reduce the occurrence of cerebral vasospasm, decrease Vm, MCA, CRP and ET-1, effectively relieve cerebral vasospasm, reduce the level of inflammatory mediators, reduce the production of vasoconstrictor and decrease the incidence of cerebral vasospasm Patients with traumatic cerebral infarction, improve prognosis.