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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]. 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]. 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
[1]
陈敏, 钟建国. 阵发性交感神经过度兴奋的诊断及治疗进展[J]. 临床神经病学杂志, 2017, 30(2): 154-156. DOI: 10.3969/j.issn.1004-1648.2017.02.026.Chen M, Zhong JG. Progress in diagnosis and treatment of paroxysmal sympathetic hyperexcitation[J]. J Clin Neurol, 2017,30(2):154-156.DOI:10.3969/j.issn.1004-1648.2017.02.026.
[2]
Morinaga Y, Nii K, Hanada H, et al. Efficacy of trazodone for treating paroxysmal sympathetic hyperactivity presenting after left temporal subcortical hemorrhage[J]. Intractable Rare Dis Res,2020,9(2):119-122.DOI:10.5582/irdr.2020.01021.
[3]
Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit[J]. Neurol Res, 2007, 29(7): 680-682.DOI:10.1179/016164107x240071.
[4]
林颖,余旻,谭香,等.创伤性脑损伤后阵发性交感神经过度兴奋综合征的研究进展[J].临床神经外科杂志,2024,21(2):211-215.DOI:10.3969/j.issn.1672-7770.2024.02.018.Lin Y, Yu W, Tan X. Research progress of paroxysmal sympathetic hyperactivity syndrome following traumatic brain injury[J].J Chin Neurosurg,2024,21(2):211-215.DOI:10.3969/j.issn.1672-7770.2024.02.018.
[5]
Perkes IE, Menon DK, Nott MT, et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria.Brain Inj,2011,25(10): 925-932.DOI:10.3109/02699052.2011.589797.
[6]
Baguley IJ, Perkes IE, Fernandez-Ortega JF, et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma,2014,31(17):1515-1520.DOI:10.1089/neu.2013.3301.
[7]
陈慧杰,孙东东.血清S-100β 神经元特异性烯醇化酶水平与脑卒中患者神经功能损害程度的相关性研究[J].中国实用神经疾病杂志, 2021, 24(5): 420-424. DOI: 10.12083/SYSJ.2021.01.003.Chen HJ, Sun DD. Study on the relationship between the levels of S-100β and NSE and the degree of neurological impairment in stroke patients[J]. Chinese Journal of Practical Nervous Diseases,2021,24(5):420-424.DOI:10.12083/SYSJ.2021.01.003.
[8]
Rakhit S, Nordness MF, Lombardo SR, et al. Management and challenges of severe traumatic brain injury[J]. Semin Respir Crit Care Med,2021,42(1):127-144.DOI:10.1055/s-0040-1716493.
[9]
王玉明.阵发性交感神经过度兴奋综合征诊断及治疗进展[J].中风与神经疾病杂志, 2022, 39(5): 469-471. DOI: 10.19845/j.cnki.zfysjjbzz.2022.0121.Wang YM. Progress in diagnosis and treatment of paroxysmal sympathetic hyperexcitation syndrome[J]. J Apoplexy and Nervous Diseases, 2022, 39(5): 469-471. DOI: 10.19845/j.cnki.zfysjjbzz.2022.0121.
[10]
Zheng RZ,Lei ZQ,Yang RZ,et al.Identification and management of paroxysmal sympathetic hyperactivity after traumatic brain injury[J]. Front Neurol, 2020, 11: 81. DOI: 10.3389/fneur.2020.00081.
[11]
李红洁,王勇强.阵发性交感神经过度兴奋综合征的研究进展[J].继续医学教育,2021,35(4):63-65.DOI:10.3969/j.issn.1004-6763.2021.04.035.Li HJ, Wang YQ. Research progress of paroxysmal sympathetic hyperexcitation syndrome[J]. Continuing Medical Education,2021,35(4):63-65.DOI:10.3969/j.issn.1004-6763.2021.04.035.
[12]
Shald EA, Reeder J, Finnick M, et al. Pharmacological treatment for paroxysmal sympathetic hyperactivity[J]. Crit Care Nurse,2020,40(3):e9-e16.DOI:10.4037/ccn2020348.
[13]
唐璐,姜波涛,张丹,等.PSH-AM量表可用于重度颅脑损伤所致阵发性交感神经过度兴奋综合征的诊断[J].内科急危重症杂志,2021,27(4):290-293,319.DOI:10.11768/nkjwzzzz 20210408.Tang L, Jang BT, Zhang D, et al. PSH-AM scale can be used in the diagnosis of paroxysmal sympathetic hyperactivity syndrome caused by severe brain injury[J]. Journal of Internal Intensive Medicine, 2021, 27(4): 290-293, 319. DOI: 10.11768/nkjwzzzz 20210408.
[14]
Marklund N, Bellander BM, Godbolt AK, et al. Treatments and rehabilitation in the acute and chronic state of traumatic brain injury[J]. J Intern Med, 2019, 285(6): 608-623. DOI: 10.1111/joim.12900.
[15]
O'Keefe LM, Mui G. Treating paroxysmal sympathetic hyperactivity with enteral baclofen in anoxic brain injury[J]. Neurologist, 2020,25(2):24-25.DOI:10.1097/nrl.0000000000000258.
[16]
王代旭,熊左隽,幸标,等.重型颅脑损伤并发阵发性交感神经功能亢进78 例[J]. 中国临床神经外科杂志, 2021, 26(4): 281-282.DOI:10.13798/j.issn.1009-153X.2021.04.017.Wang DX, Xiong ZX, Xing B. Seventy-eight cases of severe craniocerebral injury complicated with paroxysmal hypersympathetic function [J]. Chin J Clin Neurosurg, 2021, 26(4): 281-282. DOI:10.13798/j.issn.1009-153X.2021.04.017.
[17]
Hwang L, Choi IY, Kim SE, et al. Dexmedetomidine ameliorates intracerebral hemorrhage - induced memory impairment by inhibiting apoptosis and enhancing brain-derived neurotrophic factor expression in the rat hippocampus[J]. Int J Mol Med, 2013,31(5):1047-1056.DOI:10.3892/ijmm.2013.1301.
[18]
Hinson HE,Puybasset L,Weiss N,et al.Neuroanatomical basis of paroxysmal sympathetic hyperactivity: a diffusion tensor imaging analysis[J]. Brain Inj, 2015, 29(4): 455-461. DOI: 10.3109/0269 9052.2014.995229.
[19]
胡霁云,谢树才,张丽娜.神经重症患者与阵发性交感神经兴奋[J]. 临床内科杂志, 2022, 39(2): 76-79. DOI: 10.3969/j.issn.1001-9057.2022.02.002.Hu JY, Xie SC, Zhang LN. Paroxysmal sympathetic excitation in patients with severe neurological conditions[J]. J Clin Intern Med,2022,39(2):76-79.DOI:10.3969/j.issn.1001-9057.2022.02.002.
[20]
Tang Q, Wu X, Weng W, et al. The preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe traumatic brain injury patients who have undergone surgery: a retrospective study[J]. PeerJ, 2017, 5: e2986. DOI:10.7717/peerj.2986.
[21]
Echeverría-Palacio CM, Agut T, Arnaez J, et al. Neuron-specific enolase in cerebrospinal fluid predicts brain injury after sudden unexpected postnatal collapse[J]. Pediatr Neurol, 2019, 101: 71-77.DOI:10.1016/j.pediatrneurol.2019.02.020.
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