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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 233 -237. doi: 10.3877/cma.j.issn.2095-9141.2024.04.007

临床研究

颅脑外伤后阵发性交感神经兴奋患者的药物治疗效果分析
汤畅通1, 王永楠1,†(), 王诗筌1   
  1. 1. 221000 江苏徐州，徐州市中心医院（南京医科大学徐州临床医学院）神经外科
  • 收稿日期:2024-04-02 出版日期:2024-08-15
  • 通信作者: 王永楠
  • 基金资助:
    江苏省科技局基金（BL2014028）江苏省卫生健康委科研课题（Ym2023012）徐州市科技项目（KC22175）

Analysis of drug treatment efficacy in patients with post-traumatic sympathetic hyperactivity following cranial trauma

Changtong Tang1, Yongnan Wang1,†(), Shiquan Wang1   

  1. 1. Xuzhou Central Hospital(The Xuzhou School of Clinical Medicine of Nanjing Medical University),Xuzhou 221000,China
  • Received:2024-04-02 Published:2024-08-15
  • Corresponding author: Yongnan Wang
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汤畅通, 王永楠, 王诗筌. 颅脑外伤后阵发性交感神经兴奋患者的药物治疗效果分析[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 233-237.

Changtong Tang, Yongnan Wang, Shiquan Wang. Analysis of drug treatment efficacy in patients with post-traumatic sympathetic hyperactivity following cranial trauma[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(04): 233-237.

目的

分析颅脑外伤后阵发性交感神经兴奋（PSH）的药物治疗效果。

方法

选取徐州市中心医院神经外科自2018 年1 月至2022 年6 月收治的68 例颅脑外伤后出现PSH 的患者为研究对象。采用随机数字表法将患者分为对照组和治疗组，每组34例。2组患者均给予吸氧、适当控制颅压、维持脑灌注稳定、营养支持等基础治疗，对照组口服普萘洛尔，治疗组口服普萘洛尔联合右美托咪定泵入。观察2 组患者ICU 住院时长和用药后PSH 的发作频次。比较2 组患者治疗前后PSH-AM 评分、肿瘤坏死因子-α（TNF-α）、血清神经元特异性烯醇化酶（NSE）及中枢神经特异性蛋白-β（S100-β）水平变化。

结果

治疗组患者的ICU 住院时长、PSH 发作频次较对照组减少，差异有统计学意义（P＜0.05）。治疗后，2组患者的PSH-AM评分均低于治疗前，且治疗组低于对照组，差异有统计学意义（P＜0.05）。2组患者治疗后的TNF-α、NSE、S100-β水平均低于治疗前，且治疗组均低于对照组，差异有统计学意义（P＜0.05）。

结论

颅脑外伤后出现PSH 时，普萘洛尔联合右美托咪定能更有效地控制交感神经兴奋症状，减轻神经系统损伤。

关键词: 颅脑外伤, 阵发性交感神经兴奋, 药物治疗, 肿瘤坏死因子α, 中枢神经特异性蛋白-β, 神经元特异性烯醇化酶

Objective

To analyze the therapeutic effect of medication on paroxysmal sympathetic hyperactivity (PSH) after cranial trauma.

Methods

Sixty-eight patients with PSH after cranial trauma admitted to Neurosurgery Department of Xuzhou Central Hospital from January 2018 to June 2022 were selected as the research subjects. Patients were divided into control group and treatment group using a random number table method, with 34 cases in each group. Both groups of patients were given basic treatments such as oxygen therapy, appropriate control of intracranial pressure, maintenance of stable cerebral perfusion, and nutritional support. The control group received oral propranolol, while the treatment group received oral propranolol combined with dexmedetomidine infusion. The length of ICU stay and frequency of PSH attack were compared between the two groups.Changes in PSH-AM scores and levels of tumor necrosis factor α (TNF-α), serum neuron specific enolase (NSE), and central nervous system specific protein β (S100-β) were compared before and after treatment with two different regimens.

Results

The length of ICU stay and frequency of PSH attacks in the treatment group were significantly reduced compared to the control group (P＜0.05).After treatment,the PSH-AM scores of both groups were lower than before treatment, and the treatment group were lower than the control group, with statistical significance (P＜0.05). The average levels of TNF-α, NSE, and S100-β in two groups after treatment were lower than before treatment, and the treatment group were lower than the control group, with statistical significance (P＜0.05).

Conclusion

In patients with PSH after cranial trauma, the combination of propranolol and dexmedetomidine in treatment can more effectively control symptoms of sympathetic hyperactivity and alleviate neurological damage.

Key words: Cranial trauma, Paroxysmal sympathetic hyperactivity, Drug treatment, Tumor necrosis factor α, S100-β protein, Neuron specific enzyme
表1 2组患者ICU住院时长和治疗后1个月的发作频次比较[M(P25，P75)]
Tab.1 Comparison of the length of ICU stay and seizure frequency one month after treatment between two groups[M(P25，P75)]
组别 例数 ICU住院时长（d） 发作频次（次）
对照组 34 22（18.50，24.00） 1（1，1）
治疗组 34 14（10.00，19.25） 1（0，1）
Z值 -4.536 -4.245
P值 ＜0.001 ＜0.001
表2 2组患者治疗前后PSH-AM评分比较（分，±s）
Tab.2 Comparison of PSH-AM score between two groups before and after treatment(score,Mean±SD)
组别 例数 治疗前 治疗后 t值 P值
对照组 34 16.44±3.15 6.68±2.72 13.678 ＜0.001
治疗组 34 16.65±2.23 4.15±1.81 25.386 ＜0.001
t值 -0.311 4.518
P值 0.757 ＜0.001
表3 2组患者治疗前后TNF-α、NSE、S100-β水平比较（±s）
Tab.3 Comparison of TNF-α,NSE,S100-β levels between two groups before and after treatment(Mean±SD)
组别 例数 TNF-α（ng/L） NSE（g/mL） S100-β（pg/mL）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
对照组 34 40.16±5.48 40.61±5.55 -0.341 0.734 18.12±7.04 9.40±3.67 6.396 ＜0.001 152.44±38.65 76.82±8.12 11.166 ＜0.001
治疗组 34 42.33±6.34 33.96±4.65 -6.206 ＜0.001 20.28±8.21 7.46±2.89 -8.585 ＜0.001 148.71±55.05 64.56±3.81 8.892 ＜0.001
t值 -1.510 5.362 -1.164 2.422 0.324 7.976
P值 0.136 ＜0.001 0.249 0.018 0.747 ＜0.001
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