楊曉峰,劉興河(山東省臨邑縣中醫(yī)院,山東 臨邑 251500)
中西醫(yī)結(jié)合治療重型顱腦損傷并發(fā)應(yīng)激性潰瘍療效觀察
楊曉峰,劉興河
(山東省臨邑縣中醫(yī)院,山東臨邑251500)
[摘要]目的:觀察中西醫(yī)結(jié)合治療重型顱腦損傷并發(fā)應(yīng)激性潰瘍的效果。方法:60例隨機分為治療組和對照組各30例,兩組均予以西醫(yī)治療,包括胃內(nèi)注入去甲腎上腺素冰鹽水、注射立止血、奧美拉唑等,治療組加用生大黃粉胃管內(nèi)注入治療。結(jié)果:治療組總有效率96.7%,顯效率70.0%;對照組總有效率86.7%,顯效率43.3%。兩組顯效率和總有效率比較差異有統(tǒng)計學意義(P<0.05)。結(jié)論:中西醫(yī)結(jié)合治療重型顱腦損傷并發(fā)應(yīng)激性潰瘍療效好。
[關(guān)鍵詞]重型顱腦損傷;應(yīng)激性潰瘍;中西醫(yī)結(jié)合;對照治療觀察
[Abstract]Objective:To observe the effect of the combination of TCM and western medicine in the treatment of severe craniocerebral injury complicated with stress ulcer. Method:60 cases were randomly divided into two groups evenly. The control group received western medicine treatment,including intragastric injection of noradrenaline in ice water,Reptilase,omeprazole etc while the study group were treated with rhubarb powder stomach tube injection based on western medicine treatment. Result:The total efficiency of the treatment group was 96.7% and the effective rate was 70% while that of the control group was 86.7% and 43.3% respectively. The efficiency of the treatment group and the total effective rate was significantly higher than that of the control group and there was significant efficiency and total efficiency difference in the two groups(P<0.05).Conclusion:Combination of TCM and western medicine has good therapeutic effect on severe craniocerebral injury with stress ulcer.
[Key Words]Rhubarb powder;Severe craniocerebral injury;Stress ulcer; combination of TCM and western medicine; Control treatment and observation
應(yīng)激性潰瘍是重型顱腦損傷患者常見的并發(fā)癥,治療方法除了積極治療原發(fā)病外,主要是抑酸、止血等對癥治療。臨床上用于止血的藥物較多,2010年10月至2014年9月,我們用生大黃粉配合西藥抑酸、止血等治療重型顱腦損傷并發(fā)應(yīng)激性潰瘍60例療效滿意,現(xiàn)報道如下。
60例均為本院重癥醫(yī)學科住院重型顱腦損傷患者,均有明確頭部外傷史,其中交通傷54例,墜落傷4例,打擊傷2例。入院時GCS<8分,均經(jīng)頭顱CT檢查確診,其中硬膜下血腫并腦挫裂傷40例,彌漫性軸索傷10例,腦挫裂傷6例,多發(fā)性腦內(nèi)血腫2例,硬膜外血腫2例。隨機分為兩組。治療組30例,男17例,女13例;年齡18~76歲,平均46.8歲。對照組30例,男16例,女14例;年齡18~76歲,平均46.2歲。兩組性別、年齡、受傷方式及GCS評分經(jīng)統(tǒng)計學處理無顯著差異(P>0.05),具有可比性。
診斷標準:①近期內(nèi)無消化道疾病,既往無上消化道出血史;②無嚴重肝、腎疾病;③入院前1個月未服用解熱鎮(zhèn)痛藥、腎上腺皮質(zhì)激素和神經(jīng)系統(tǒng)藥物;④顱腦損傷后出現(xiàn)嘔血、黑便等癥狀或胃液、糞便潛血試驗陽性(排除顱底骨折及口鼻腔出血被吞咽)。
兩組在治療原發(fā)病的基礎(chǔ)上均予奧美拉唑抑酸,血凝酶止血,胃管注入冰鹽水及去甲腎上腺素。治療組加用生大黃粉10g胃管內(nèi)注入,每日3~6次。用藥1~3天出血停止為有效,繼續(xù)用藥3天。如果用藥3天出血無法控制,改用其他方法治療。
顯效:用藥24h內(nèi)出血停止,胃管內(nèi)抽不出血液(胃液潛血試驗陰性)。有效:用藥72h內(nèi)出血停止(胃液潛血試驗陰性)。無效:用藥72h出血無法控制、繼續(xù)嘔血或胃管內(nèi)抽出新鮮血液,需改用其他治療方法。
兩組療效比較見表1。
表1 兩組療效比較 例(%)
大黃苦寒,歸脾、胃、大腸、肝、心經(jīng),具有瀉下攻積、清熱瀉火、止血、解毒、活血祛瘀等功效?,F(xiàn)代研究認為生大黃止血有效成分是α-兒茶素及沒食子酸,止血作用機理是促進血小板的粘附和聚集功能,有利于血栓形成;使血小板數(shù)和纖維蛋白原含量增加,凝血時間縮短;降低抗凝血酶Ⅲ(AT-Ⅲ)的活性。
應(yīng)激性潰瘍是重型顱腦損傷的嚴重并發(fā)癥,在西醫(yī)常規(guī)抑酸、止血等治療基礎(chǔ)上配合生大黃粉治療療效滿意。
[收稿日期]2015-07-20
[中圖分類號]R573.1
[文獻標識碼]B
[文章編號]1004-2814(2015)10-0925-01