【作者】 但炜；

【导师】 唐文渊；

【作者基本信息】 重庆医科大学 ， 神经外科， 2002， 硕士

【摘要】 目的：通过定量脑电图监测，探讨不同剂量的纳洛酮对急性脑伤患者不同伤情的疗效。方法：选择受伤后12小时内入院的急性脑损伤患者82例，按伤情轻重分为GCS3～5分、GCS6～8分、GCS9～12分三组。每组再分为纳洛酮治疗组和对照组。纳洛酮治疗组又分为小剂量组 (首剂负荷量1.2mg +4.8mg/d24小时内静脉持续泵入或4.8mg/d直接静脉持续泵入)及大剂量组（首剂负荷量2mg+0.3mg/kg/d24小时内静脉持续泵入）。用定量脑电图监测，观察用药前、用药后10分、30分、1h、2h、24h、48h、72hδ频段相对功率值及总功率值变化。结果：GCS9～12分组：小剂量（直接泵入组用药2h后）和大剂量纳洛酮治疗组用药10钟后，与对照组比较，其qEEG的δ频段相对功率值降低、总功率值增高，P<0.05。但治疗组内无显著性差异，P>0.05。<WP=5>GCS6～8分组：大小剂量纳洛酮治疗组用药后，上述两项脑电图指标与对照组相比均有改善,P<0.05，但大剂量组脑电图指标比小剂量组改善更明显,P<0.05。GCS3～5分组：上述两指标在纳洛酮治疗组与对照组间无显著性差异，P>0.05。结论：定量脑电图监测结果显示：本文选用的小剂量与大剂量纳洛酮对GCS9～12分中型脑伤有显著的治疗作用，但两种剂量的疗效无差异；对GCS6～8分重型脑伤，上述两种剂量虽都有明显疗效，但大剂量组疗效更显著；对GCS3～5分特重型脑伤，大剂量治疗甚至增加了首剂静脉推注量也未见明显的疗效。更多还原

【Abstract】 Objective: To reveal, by monitoring of qEEG, the effects of different dose naloxone on acute moderate and severe head injuries.Methods：82 patients with acute moderate and severe head injuries (Glasgow Coma Scale 3-12, within 12 hours after injury) were selected for this study. According to the severity of injury, all patients were classified into three groups: GCS3～5、 GCS6～8 and GCS9～12. Patients of each group were then randomly assigned to treatment with naloxone or control. In naloxone groups, low doses of naloxone (1.2mg for one minute intravenously, followed by a 24-hour infusion of 4.8mg or constant infusion of 4.8mg/d) and high doses of naloxone (2mg/2min, followed by a 24-hour infusion of 0.3/kg) were administered respectively to the patients with acute<WP=7>brain injury with different severity for three days. Relative power of δ frequency and absolute power of 1-25 frequency were monitored with qEEG before and 0、10、30 minutes、1、2、24、48、72 hours after administration.Results: In GCS 9 to 12 group, relative power ofδfrequency and absolute power of 1-25 frequency were significantly different (P<0.05) in qEEG between naloxone groups and control group, while there was no significantly different of all parameters between low-dose and high-dose naloxone groups(P>0.05).In GCS 6 to 8 group, the two parameters were improved significantly in naloxone groups and were significantly different between low-dose and high-dose naloxone groups. In GCS 3 to 5 group, all parameters were not significantly different between naloxone group and control group.Conclusions: These results suggest that treatment with naloxone in patients with GCS of 6 to 12 is beneficial in terms of improved qEEG and there is not significant difference in low-dose and high-dose naloxone in GCS 9 to 12 group, but in GCS 6 to 8 group high-dose naloxone is better than low-dose naloxone. However, in GCS 3 to 5 group, high-dose naloxone may not be so effective.更多还原