王冰,李兵,胡世颉,胡学安,邹西峰,张磊,曹宝萍,费舟
WANG Bing,LI Bing,HU Shijie,HU Xue'an,ZOU Xifeng,ZHANG Lei,CAO Baoping,FEI Zhou

• 1:第四军医大学西京医院神经外科

摘要(Abstract)：

目的:观察乌司他丁对重型颅脑损伤患者神经保护作用。方法:入院接受手术治疗的重度颅脑损伤患者90例,随机均分为观察组和对照组,观察组在常规治疗基础上给乌司他丁200 000U加入生理盐水20 mL静脉静推,2次/d,连续12 d;对照组在常规治疗基础上静脉滴注吡拉西坦,4 g/次,2次/d,连续12 d;观察2组患者治疗后12 d的格拉斯哥(GCS)评分、简明精神状态检测(MMSE)评分及6个月后格拉斯哥预后(GOS)评分,对比2组患者记忆与智能障碍、神经功能缺失及治疗后血清尿素氮(BUN)、肌酐(CR)、丙氨酸基转移酶(ALT)及总胆红素(TBIL)指标的改变。结果:治疗后两组患者的GCS评分、MMSE评分及GOS评分均有所提高,但观察组评分显著高于对照组,差异有统计学意义(P<0.05);治疗前2组患者BUN、CR、ALT及TBIL比较,差异无统计学意义(P>0.05),治疗后均较治疗前升高,但观察组低于对照组,差异有统计学意义(P<0.05)。结论:乌司他丁在治疗重度颅脑损伤患者神经保护、改善记忆与智能障碍方面有较好的临床效果,值得进一步研究和推广。
Objective: To explore the neuroprotective effect of ulinastatin on the patients with severe craniocerebral injury. Methods: Ninety cases with severe craniocerebral injury were randomly divided into ulinastatin treatment group( group U) and control group( group C). On the basis of routine therapy,patients in group U and group C received ulinastatin and piracetam respectively. The effect was assessed with GCS score and MMSE score at the 12 thday and GOS score at 6 months after treatment. The changes of serum urea nitrogen( BUN),creatinine( CR),alanine aminotransferase( ALT) and total bilirubin( TBIL) levels after treatment were detected. Results: After treatment,GCS scores,MMSE scores and GOS scores were increased in the two groups,and the scores in group U were higher than those in group C( P < 0. 05). There was no significant difference in BUN,CR,ALT and TBIL levels between the two groups before treatment( P > 0. 05),after treatment,the levels of these indexes were increased,but those of group U were lower than those of group C( P < 0. 05). Conclusions: Ulinastatin has good effect in protecting nerve,improving memory and intelligence disorder in patients with severe craniocerebral injury.

关键词(KeyWords)： 颅脑损伤;神经保护药;乌司他丁;肝功能试验;肾功能试验;损伤严重度评分
craniocerebral injury;neuroprotective agents;ulinastatin;liver function tests;renal fuction tests;injury severity score

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金青年科学项目(81101710)

作者(Author): 王冰,李兵,胡世颉,胡学安,邹西峰,张磊,曹宝萍,费舟
WANG Bing,LI Bing,HU Shijie,HU Xue'an,ZOU Xifeng,ZHANG Lei,CAO Baoping,FEI Zhou

DOI: 10.19367/j.cnki.1000-2707.2014.05.014

参考文献(References)：

• [1]刘晓晖.重症颅脑损伤32例死亡分析[J].安徽医药,2008(4):344.
• [2]景丙文.乌司他丁在急危重症临床应用的进展[J].中国危重症急救医学,2006(2):117-120.
• [3]王开磊.创伤性颅脑损伤后细胞免疫和相关生化指标的动态变化及乌司他丁的干预作用临床对照研究[D].上海:第二军医大学,2009.
• [4]Du HG,Yin LC,He M,et al.Application of ulinastatin in severe craniocerebral injuries[J].Chin J Traumatol,2005(4):236-9.
• [5]周良辅.现代神经外科学[M].上海:复旦大学出版社,2001:216-221.
• [6]田彬,谢梦玲,梁义章.颅脑损伤后血糖变化对预后的影响[J].贵阳医学院学报,2011(5):526-528.
• [7]左永明,蒲云学.191例创伤性颅脑损伤流行病学特征分析[J].贵阳医学院学报,2011(2):181-183.
• [8]White BC,Sullivan JM,DeGracia DJ,et al.Brain ischemia and reperfusion:molecular mechanisms of neuronal injury[J].J Neurol Sci,2000(S1-2):1-33.
• [9]李燕真.吡拉西坦固体脂质纳米粒的制备和脑靶向性的研究[D].开封:河南大学,2010.
• [10]Shu Y,Yang Y,Qiu W,et al.Neuroprotection by ulinastatin in experimental autoimmune encephalomyelitis[J].Neurochem Res,2011(11):1969-1977.
• [11]Pramod KD,Jing Z.Biomarkers for the diagnosis,prognosis,and evaluation of treatment efficacy for traumatic brain injury[J].Neurotherapeutics,2010(7):100-114.
• [12]Shu YQ,Yang Y,Wang YG,et al.Combined therapy with methylprednisolone and ulinastatin in experimental autoimmune encephalomyelitis[J].Chin Med J(Engl),2013(18):3439-3445.
• [13]章国军,杜杭根,殷利春,等.乌司他丁在重型颅脑损伤应用中血浆内皮素水平的变化[J].浙江中医学院学报,2004(2):212-214.

文章评论(Comment)：