单唾液酸四己糖神经节苷脂对重型颅脑创伤后颅内压增高的治疗作用VIP免费

收稿日期:2009－06－05作者简介:屈阳(1980－)，男，陕西西乡县人，在读硕士研究生，主要从事颅脑创伤方向的研究。单唾液酸四己糖神经节苷脂对重型颅脑创伤后颅内压增高的治疗作用屈阳1，2，张赛2，杨树源1(1.天津医科大学总医院神经外科，天津300052;2.武警医学院附属医院脑系科中心，天津300162)摘要:目的探讨单唾液酸四己糖神经节苷脂(GM1)对重型颅脑创伤(sTBI)患者颅内压(ICP)增高和脑水肿的治疗作用。方法选取临床sTBI患者44例，随机分为对照组及观察组各22例，2组患者均予以气管切开、亚低温治疗、标准外伤开颅去大骨瓣手术治疗。对照组患者予以脱水、抗感染、纠正水电解质平衡、营养支持等常规治疗;观察组患者在对照组常规治疗的基础上加GM1钠盐注射液100mg静脉滴注，每日1次，持续7d。分别监测2组患者治疗前及治疗后2h、4h、6h、8h、3d和7d的ICP值;无创脑水肿监测仪分别监测2组患者治疗前和治疗后1d、3d、5d和7d脑水肿扰动系数;治疗7d后复查头颅CT评价患者的脑水肿缓解状况并比较2组患者格拉斯哥昏迷评分(GCS)。结果观察组患者治疗4h后ICP较对照组下降(P<0.05)，治疗3d后脑水肿扰动系数较对照组下降(P<0.05)，治疗7d后头颅CT提示脑水肿的缓解满意度大于对照组(P<0.05)，GCS较对照组高(P<0.05)。结论GM1对于早期sTBI患者有一定的降颅压、缓解脑水肿的作用，可以改善患者昏迷程度。关键词:单唾液酸四己糖神经节苷脂;重型颅脑创伤;脑水肿;颅内压中图分类号:R651.1+5文献标识码:A文章编号:1004-7239(2009)06-0596-04EffectofmonosialotetrahexosylgangliosideonreducingtheincreasedintracranialpressureinthepatientswithacuteseveretraumaticbraininjuryQUYang1，2，ZHANGSai2，YANGShu-yuan1(1.DepartmentofNeurosurgeon，GeneralHospitalofTianjinMedicalUniversity，Tianjin300052，China;2.DepartmentofNeurosurgeon，theAffiliatedHospitalofMedicalCollegeofChinesePeople′sArmedPoliceForce，Tianjin300162，China)Abstract:ObjectiveTostudytheeffectofmonosialotetrahexosylganglioside(GM1)onreducingtheincreasedintracranialpressure(ICP)andalleviatingthebrainedemainthepatientswithacuteseveretraumaticbraininjury(sTBI).Methods44patientswithsTBIweredividedintoobservationgroup(n=22)andcontrolgroup(n=22)randomly.Incisionoftrachea，mildhypothermiatreatmentandbone-flapremovesurgeryweredoneinthetwogroups.Theconventionaltreatmentssuchasehydration，anti-infectiondrug，retrievingthebalanceofwaterelectrolyteandnutritionsupportingweredoneinthecontrolgroup.Basedontheconventionaltreatments，intravenousdripwithGM1salineinjection100mgwasaddedinobservationgroup，once-dailyfor7days.ThechangesofICPat2hours，4hours，6hours，8hours，3daysand7daysweremonitoredandthebrainedemaindexat1day，3days，5daysand7dayswereobservedwithnoninvasivethecerebraledemamonitorbeforeandaftertreatmentinthetwogroups.ThestateofthereliefofbrainedemawasevaluatedbybrainCTscanat7daysaftertreatmentandtheglasgowcomascores(GCS)intwogroupswerecontrasted.ResultsTheICPat4hoursaftertreatmentandthebrainedemaindexat3daysaftertreatmentinGM1therapygroupwerelowerthanthoseinthecontrolgroup(P<0.05);At7daysaftertreatmentbrainCTscanindicatedthatthedegreeofsatisfactionofthereliefofbrainedemawashigherthanthatinthecontrolgroup(P<0.05);TheGCSscoreswerehigherthanthoseinthecontrolgroup(P<0.05).ConclusionGM1canreducetheincreasedICPandalleviatethebrainedemaatearlystageofsTBI，andcanimprovethelevelofcomainthepatients.Keywords:monosialotetrahexosylganglioside;severetraumaticbraininjury;brainedema;intracranialpressure单唾液酸四己糖神经节苷脂(monosialotetra-hexosylganglioside，GM1)是含唾液酸的糖神经鞘脂，存在于哺乳动物的细胞膜中，神经系统中含量尤其丰富，是神经细胞膜的组成成分，在神经的...