甘露醇开放血脑屏障后应用神经生长因子对重型颅脑损伤治疗的研究(1)
【摘要】目的：观察甘露醇开放血脑屏障后应用神经生长因子(NGF)局部注射促进重型颅脑损伤患者预后的效果。方法：将368例重型颅脑损伤患者随机分为对照组、治疗组和特殊治疗组。对照组给予常规神经外科治疗；治疗组在对照组基础上给予神经生长因子12 μg肌注，1次/d，连续15 d；特殊治疗组在肌注神经生长因子12 μg后20 min即快速静注20%甘露醇250 ml，连续15 d。以三组患者3个月后GOS评分为预后观察指标对三组患者恢复情况作出对比分析。结果：三组病例均获随访，经统计学处理，治疗组疗效优于对照组(P<0.05)，特殊治疗组疗效优于对照组和治疗组(P<0.05)。结论：甘露醇开放血脑屏障后应用神经生长因子(NGF)能提高外源性神经生长因子的疗效，对改善重型颅脑损伤患者预后能起到较为明确的作用。
【关键词】神经生长因子；重型颅脑损伤；甘露醇
The Curative Effects of Nerve Growth Factor in Serve Brain Injury After Opening the Blood Brain Barrier with the Venous Rapid Drip of Mannitol/WU Guo-biao， CHEN Yong-qun， WANG Kang.//Medical Innovation of China，2012，9(15)：102-103
, 百拇医药
【Abstract】Objective： To investigate the curative effects of nerve growth factor(NGF) in serve brain injury after opening the blood brain barrier with the venous rapid drip of mannitol. Methods： 368 patients with severe brain injury were divided into three groups： control group， common NGF treatment group， and special NGF treatment group. The patients in common NGF group were treated with NGF intramuscular injection， and the other treatment was the same as that of the control group. The special NGF treatment used mannitol to open the blood brain barrier before NGF intramuscular injection. The clinical data， changes of GOS in patients of these three groups were observed and compared with. Results： According to GOS scoring of the tracking investigation in three months after injury， the score in patients of common NGF treat group had been remarkably higher than that of control group(P<0.05)， and the score of special NGF treat group GOS was significantly higher than that of common NGF group(P<0.05). There were no obvious adverse reactions observed. Conclusion： Early application of NGF after opening the blood brain barrier with the venous rapid drip of mannitol can significantly accelerate the recovery of nervous function， and improve the prognosis of patients with severe brain injury.
, 百拇医药
【Key words】Nerve growth factor(NGF)；Severe brain injury；Mannitol
First-author’s address： The Xinhui People’s Hospital Affiliated Southern Medical University， Xinhui 529100， China
doi：10.3969/j.issn.1674-4985.2012.15.064
神经生长因子(nerve growth factor， NGF)是Levi-Montalcini于1952年发现的生长因子，是一种能够促进神经细胞生长的生物活性复合蛋白[1]。NGF在神经系统中调节中枢和外周神经元生长、发育、分化以及维持正常存活的作用已得到公认[2]。近十余年国内外已广泛用于临床治疗神经系统的疾病。重型颅脑损伤致死、致残率高，是严重威胁人类健康的疾病。笔者应用甘露醇开放血脑屏障后应用神经生长因子治疗重型颅脑损伤，取得了较好的临床疗效，现报道如下。
, 百拇医药
1资料与方法
1.1一般资料选择2007年1月-2012年1月患者共368例，其中男238例，女130例，平均35.2岁；其中单纯硬膜外血肿77例，各类颅内血肿239例，弥漫性轴索损伤(包括原发性脑干损伤)40例。纳入标准：均有明确头颅外伤史，均在伤后8 h内入院，伤后昏迷时间均超过6 h，伤后8 h左右格拉斯哥昏迷评分均为6～8分，无严重复合伤，受伤前无明显其他疾病，入院后均经头颅CT检查明确诊断。手术治疗213例，非手术治疗155例。患者入院后按性别、年龄相差范围、致伤原因、GCS评分、影像学表现等相同或相似的原则分为三组，对照组120例、NGF常规治疗组123例和NGF特殊治疗组125例。三组患者一般资料比较差异无统计学意义(P>0.05)，具有可比性。
1.2方法对照组给予常规神经外科治疗，治疗组在对照组基础上给予神经生长因子12 μg肌注，1次/d，连续15 d；特殊治疗组在肌注神经生长因子12 μg后20 min即快速静注20%甘露醇250 ml，连续15 d。
1.3观察指标外伤3月后随诊GOS评分，观察患者不良反应。
1.4统计学处理使用SPSS 12.0统计软件，计量资料采用t检验，以P<0.05为差异有统计学意义。
2结果
2.1三组随访GOS评分比较三组3个月后平均GOS评分分别为：对照组(3.01±0.92)分，治疗组(3.49±0.87)分，特殊治疗组(4.07±1.02)分。治疗组评分高于对照组(P<0.05)，特殊治疗组评分高于对照组和治疗组(P<0.05)。, 百拇医药(吴国彪 陈永群 王康)
【关键词】神经生长因子；重型颅脑损伤；甘露醇
The Curative Effects of Nerve Growth Factor in Serve Brain Injury After Opening the Blood Brain Barrier with the Venous Rapid Drip of Mannitol/WU Guo-biao， CHEN Yong-qun， WANG Kang.//Medical Innovation of China，2012，9(15)：102-103
, 百拇医药
【Abstract】Objective： To investigate the curative effects of nerve growth factor(NGF) in serve brain injury after opening the blood brain barrier with the venous rapid drip of mannitol. Methods： 368 patients with severe brain injury were divided into three groups： control group， common NGF treatment group， and special NGF treatment group. The patients in common NGF group were treated with NGF intramuscular injection， and the other treatment was the same as that of the control group. The special NGF treatment used mannitol to open the blood brain barrier before NGF intramuscular injection. The clinical data， changes of GOS in patients of these three groups were observed and compared with. Results： According to GOS scoring of the tracking investigation in three months after injury， the score in patients of common NGF treat group had been remarkably higher than that of control group(P<0.05)， and the score of special NGF treat group GOS was significantly higher than that of common NGF group(P<0.05). There were no obvious adverse reactions observed. Conclusion： Early application of NGF after opening the blood brain barrier with the venous rapid drip of mannitol can significantly accelerate the recovery of nervous function， and improve the prognosis of patients with severe brain injury.
, 百拇医药
【Key words】Nerve growth factor(NGF)；Severe brain injury；Mannitol
First-author’s address： The Xinhui People’s Hospital Affiliated Southern Medical University， Xinhui 529100， China
doi：10.3969/j.issn.1674-4985.2012.15.064
神经生长因子(nerve growth factor， NGF)是Levi-Montalcini于1952年发现的生长因子，是一种能够促进神经细胞生长的生物活性复合蛋白[1]。NGF在神经系统中调节中枢和外周神经元生长、发育、分化以及维持正常存活的作用已得到公认[2]。近十余年国内外已广泛用于临床治疗神经系统的疾病。重型颅脑损伤致死、致残率高，是严重威胁人类健康的疾病。笔者应用甘露醇开放血脑屏障后应用神经生长因子治疗重型颅脑损伤，取得了较好的临床疗效，现报道如下。
, 百拇医药
1资料与方法
1.1一般资料选择2007年1月-2012年1月患者共368例，其中男238例，女130例，平均35.2岁；其中单纯硬膜外血肿77例，各类颅内血肿239例，弥漫性轴索损伤(包括原发性脑干损伤)40例。纳入标准：均有明确头颅外伤史，均在伤后8 h内入院，伤后昏迷时间均超过6 h，伤后8 h左右格拉斯哥昏迷评分均为6～8分，无严重复合伤，受伤前无明显其他疾病，入院后均经头颅CT检查明确诊断。手术治疗213例，非手术治疗155例。患者入院后按性别、年龄相差范围、致伤原因、GCS评分、影像学表现等相同或相似的原则分为三组，对照组120例、NGF常规治疗组123例和NGF特殊治疗组125例。三组患者一般资料比较差异无统计学意义(P>0.05)，具有可比性。
1.2方法对照组给予常规神经外科治疗，治疗组在对照组基础上给予神经生长因子12 μg肌注，1次/d，连续15 d；特殊治疗组在肌注神经生长因子12 μg后20 min即快速静注20%甘露醇250 ml，连续15 d。
1.3观察指标外伤3月后随诊GOS评分，观察患者不良反应。
1.4统计学处理使用SPSS 12.0统计软件，计量资料采用t检验，以P<0.05为差异有统计学意义。
2结果
2.1三组随访GOS评分比较三组3个月后平均GOS评分分别为：对照组(3.01±0.92)分，治疗组(3.49±0.87)分，特殊治疗组(4.07±1.02)分。治疗组评分高于对照组(P<0.05)，特殊治疗组评分高于对照组和治疗组(P<0.05)。, 百拇医药(吴国彪 陈永群 王康)