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目的探讨应用静脉注射法舒地尔(Fasudil)对重度脑挫裂伤(severe cerebral contusion)患者的治疗作用。方法颅脑外伤并重度脑挫伤患者64例(格拉斯哥昏迷评分GCS≤8分),随机分为对照组32例,伤后予常规治疗:脱水,抗炎,激素,神经营养等;研究组(静脉注射法舒地尔组)32例,伤后3d内予常规治疗加法舒地尔静脉滴注,首次剂量法舒地尔30mg加生理盐水100ml缓慢静脉滴注(30min),2次/d,使用3d观察无不良反应后,将法舒地尔用量增加到60mg加生理盐水250ml缓慢静脉滴注(60min),2次/d。连续治疗14d。在治疗前后对患者均进行GCS评分、头部CT测量脑水肿、TCD检查监测局部脑血流、治疗后对神经功能缺损评估。结果研究组法舒地尔治疗7d后即出现GCS评分上升、脑水肿减轻、伤侧脑组织血流供应改善;治疗14d神经功能缺损评估研究组疗效优于对照组(P<0.05)。结论静脉注射法舒地尔能明显缓解颅脑损伤患者脑血管痉挛,改善脑微循环,减轻脑水肿,促进脑功能恢复。
Objective To investigate the therapeutic effect of intravenous Fasudil on patients with severe cerebral contusion. Methods Sixty-four patients with craniocerebral trauma and severe brain contusion (Glasgow coma score GCS≤8) were randomly divided into control group (n = 32) and routine treatment after dehydration, anti-inflammatory, hormone and neurotrophic factors. The study group Injected Fasudil group). Thirty-two cases were given conventional therapy plus fasudil intravenously. The first dose fasudil 30mg plus saline 100ml slow intravenous drip (30min), twice a day 3d observed no adverse reactions, fasudil dosage increased to 60mg plus normal saline 250ml slow intravenous infusion (60min), 2 times / d. Continuous treatment 14d. Before and after treatment, GCS was performed on all patients, cerebral edema was measured by CT on the head, local cerebral blood flow was monitored by TCD, and neurological deficits were evaluated after treatment. Results After fasudil treatment for 7 days, GCS score increased, cerebral edema decreased and blood supply to injured side of brain improved. The efficacy of neurological deficit assessment group on 14th day was better than that of control group (P <0.05). Conclusion Intravenous fasudil can significantly relieve cerebral vasospasm, improve cerebral microcirculation, reduce cerebral edema and promote recovery of brain function in patients with craniocerebral injury.