作者：刘晓祥 杜忠胜 明大庆 宁新玲 孙洪玉
【摘要】 目的 探讨常规治疗和应用神经节苷脂（GM?1）治疗重型颅脑损伤的临床效果。方法 88例重型颅脑损伤病例随机分为GM?1治疗组(n=46)和对照组(n=42)，对照组进行常规治疗，GM?1治疗组在常规治疗的基础上使用GM?1，观察治疗时期两组病人的颅脑CT、生命体征的变化，并对两组患者进行GCS评分、NFD评分及2个月后GOS评分，以此评定两组患者的预后。结果 GM?1治疗组病人呼吸异常（19.57％）和心律异常（21.74％）均较对照组显著减少（P<0.01），重度脑水肿（21.74％）的发生也较对照组明显减少（P<0.05）；治疗10 d后治疗组GCS分值较对照组提高，神经功能缺失（NFD）评分较对照组降低，随访2个月GOS评分Ⅴ级者（69.57%），较对照组（47.62%）提高（P＜0?05）。结论 GM?1可减轻脑水肿，降低颅内压，改善脑供血，促进患者神经功能恢复，改善预后。
【关键词】 神经节苷脂；颅脑损伤；治疗
【Abstract】 Objective To study the clinical effects of routine treatment and GM?1 for acute severe traumatic brain injuries.Methods 88 patients with acute severe traumatic brain injury were randomly divided into GM?1 treatment group (n=46) and control group (n=42). The two groups both received routine treatment, but the treatment group was also treated with GM?1. The clinical data, including vital signs, cerebral edema, GCS score, NFD score and GOS score, were observed after treatment. Results The fluctuation of vital signs was smoother in GM?1 treatment group than control group, including arrhythmia (P<0.01) and abnormal respiration (P<0.01). CT scanning showed that the severity of brain edema was less remarkable (P<0.05). More patients revived in GM?1 treatment group than control group (P<0.01) in 10 days accompanied by higher recovery rate of neurologic impairment (P<0.01) and lower disability (P<0.05) after two months. Conclusion The use of GM?1 can effectively relieve traumatic brain edema, improve recovery of coma and neurologic impairment, and reduce disability in acute severe traumatic brain injuries.
【Key words】 gangliosides，traumatic brain injury，treatment
重型颅脑损伤(severe traumatic brain injury)是严重危及人类生命的疾病之一，病死率高达30%~58%［1］。本文总结我院自2002年3月—2006年3月88例重型颅脑损伤病例的救治情况，现报道如下。
1 资料与方法
1.1 临床资料 88例患者中，男56例，女32例，年龄15～81岁，平均年龄46?8岁。将入选病例随机分为GM?1治疗组(n=46)和对照组(n=42)。GM?1治疗组：男28例，女18例，平均年龄48?1岁；损伤原因：车祸伤23例，摔伤14例，打击伤9例；按GCS计分，3~5分17例，6～8分29例；硬膜外血肿9例，硬膜下血肿12例，脑挫裂伤17例，脑内血肿6例，复合性血肿2例；手术治疗27例，非手术治疗19例。对照组：男25例，女17例，平均年龄47.6岁；损伤原因：车祸伤21例，摔伤13例，打击伤8例；GCS计分，3~5分16例，6～8分26例；硬膜外血肿7例，硬膜下血肿10例，脑挫裂伤16例，脑内血肿4例，复合性血肿5例；手术治疗25例，非手术治疗17例。两组患者在性别、年龄、病因、病程及病情等方面均经χ2检验，无显著性差异(P>0.05)，具有可比性。