目的 觀察奧拉西坦聯(lián)合尼莫地平治療重癥腦挫裂傷的臨床療效。方法 選取新疆醫(yī)科大學(xué)第二附屬醫(yī)院2010年11月-2014年10月收治的重癥顱腦損傷患者130例,隨機(jī)分為對(duì)照組(68例)和治療組(62例)。兩組患者術(shù)后均轉(zhuǎn)入ICU監(jiān)護(hù)并給予等常規(guī)治療,對(duì)照組給予尼莫地平注射液4 mg/次,加入到250 mL生理鹽水中靜脈滴注,1次/d。治療組在對(duì)照組基礎(chǔ)上加用注射用奧拉西坦,4 g/次,加入到250 mL生理鹽水中緩慢靜滴,1次/d。兩組均連續(xù)治療14 d。比較兩組的臨床療效,同時(shí)比較兩組治療前,治療第3、7、14天神經(jīng)功能缺損(NIHSS)評(píng)分、顱內(nèi)壓、GCS評(píng)分、腦電圖快慢波比值、大腦中動(dòng)脈(McA)平均血流速度、雙側(cè)平均肌力的變化。結(jié)果 對(duì)照組和治療組總有效率分別為61.76%、80.65%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。對(duì)照組NIHSS評(píng)分從治療第7天,治療組從治療第3天開(kāi)始顯著下降,同組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。從治療第3天開(kāi)始治療組NIHSS評(píng)分顯著低于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05、0.01)。兩組顱內(nèi)壓均從治療第3天開(kāi)始降低,GCS評(píng)分、McA平均血流速度、雙側(cè)平均肌力從治療第3天開(kāi)始升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療組從治療第3天開(kāi)始,GCS評(píng)分、McA平均血流速度高于對(duì)照組,治療組在治療第3、7天顱內(nèi)壓低于對(duì)照組,在治療第7天快慢波比值低于對(duì)照組,在治療第3、14天雙側(cè)平均肌力高于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05、0.01)。結(jié)論 奧拉西坦聯(lián)和尼莫地平治療重癥腦挫裂傷術(shù)后患者具有較好的臨床療效,可促進(jìn)患者神經(jīng)功能恢復(fù),提高患者生存質(zhì)量,為進(jìn)一步探索和治療重癥腦挫裂傷患者提供明確的思路。

Objective To explore the clinical effect of oxiracetam combined with nimodipine in treatment of severe cerebral contusion. Methods The patients with severe cerebral contusion (130 cases) of the Second Affiliated Hospital of Xinjiang Medical University from November 2010 to October 2014 were randomly divided into control (n=68) and treatment (n=62) groups. The patients in two groups were transferred to the ICU after the surgical treatment and given conventional treatment. The patients in the control group were iv administered with Nimodipine Injection 4 mg/time, which was diluted with 250 mL physiological saline once daily. The patients in the treatment group were iv administered with Oxiracetam for injection (4 g diluted with 250 mL physiological saline) on the basis of control group, once daily. The patients in two groups were treated for 14 d. After the treatment, the efficacy was evaluated, and NIHSS score, intracranial pressure, GCS score, electroencephalogram wave ratio, average blood flow velocity of middle cerebral artery (McA), and the average strength on both sides before and 3, 7, 14 d after the treatment in two groups were compared. Results The efficacies in the control and treatment groups were 61.76% and 80.65%, respectively, and there were differences between the two groups (P< 0.05). After treatment, the NIHSS score in the control group significantly reduced from the seventh day of treatment, while from the third day of treatment in the treatment group, and the difference was statistically significant in the same group (P< 0.01). NIHSS score of the treatment group was lower than that in the control group from the third day of treatment, with significant difference between two groups (P< 0.05, 0.01). Intracranial pressure in two groups was statistically reduced from the third day of treatment, and GCS score, average blood flow velocity of McA, and average strength on both sides were increased from the third day of treatment, and the difference was statistically significant in the same group (P< 0.01). GCS score, and average blood flow velocity of McA in the treatment group were higher than those in the control group from the third day of treatment, and intracranial pressure of treatment group was lower than that in the control group on the third and seventh day of treatment. Electroencephalogram wave ratio in the treatment group was lower than that in the control group on the seventh day of treatment, and the average strength on both sides in the treatment group was higher than that in the control group on the third and 14th day of treatment, with significant difference between two groups (P< 0.05, 0.01). Conclusion Oxiracetam combined with nimodipine has the good clinical effect in treatment of severe cerebral contusion, and can promote the neurologic recovery, while can improve the quality of survival, which offers a clear train of thought for further treatment of patients with severe cerebral contusion.