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目的探讨山莨菪碱对重型弥漫性轴索损伤(DAI)患者血浆神经元特异性烯醇酶(NSE)、内皮素(ET)及降钙素基因相关肽(CGRP)含量的作用及预后的影响。方法38例诊断为弥漫性轴索损伤且GCS评分为3～8分的患者被随机分成两组:治疗组(n=19)和对照组(n=19)。治疗组的患者入院后立即给予静脉持续滴注山莨菪碱0.5mg/(kg·24h),连用1周;对照组按普通常规治疗。两组患者分别于治疗前、治疗后1周采静脉血,用放射免疫法测定两组患者血浆中NSE、ET、CGRP的变化,并于伤后6个月用格拉斯哥预后评分(GOS)进行预后评定及进行统计。结果治疗组和对照组血清NSE、ET、CRPT分别为(26.70±19.73)μg/L、(36.45±8.64)ng/L、(19.93±4.32)ng/L和(49.17±23.10)ng/L、(57.31±11.14)ng/L、(23.64±6.38)ng/L,两组ET、NSE含量相比较,差异有显著性(P<0.01),治疗组生存率较对照组明显提高,差异有显著性(P<0.01)。结论使用山莨菪碱治疗弥漫性轴索损伤可降低ET和CGRP的活性,减轻脑血管痉挛所造成的脑缺血缺氧,从而提高疗效。
Objective To investigate the effect of anisodamine on plasma levels of neuronal specific enolase (NSE), endothelin (ET) and calcitonin gene related peptide (CGRP) in patients with severe diffuse axonal injury (DAI) and its prognosis . Methods Thirty-eight patients diagnosed as diffuse axonal injury with a GCS score of 3 to 8 were randomized into two groups: treatment (n = 19) and control (n = 19). The patients in the treatment group were given intravenous anisodamine 0.5 mg / (kg · 24h) immediately after admission for 1 week, and the control group was treated as usual. Venous blood was collected at 1 week after treatment and plasma NSE, ET and CGRP levels were measured by radioimmunoassay in both groups before and after treatment. The prognosis was assessed by Glasgow Outcome Scale (GOS) 6 months after injury Assessment and statistics. Results The serum levels of NSE, ET and CRPT in the treatment group and the control group were (26.70 ± 19.73) μg / L, (36.45 ± 8.64) ng / L, (19.93 ± 4.32) ng / L and (57.31 ± 11.14) ng / L and (23.64 ± 6.38) ng / L, respectively. There was significant difference between ET and NSE levels in the two groups (P <0.01). The survival rate of the treatment group was significantly higher than that of the control group (P <0.01). Conclusion Anisodamine treatment of diffuse axonal injury can reduce the activity of ET and CGRP and relieve cerebral ischemia and hypoxia induced by cerebral vasospasm, so as to improve the curative effect.