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目的研究纳洛酮治疗重型流行性乙型脑炎患儿脑脊液神经元特异性烯醇酶(NSE)的含量变化及其临床意义。方法将1999-06—2006-09在温州医学院附属育英儿童医院感染科住院的48例患儿分为纳洛酮组28例,常规组20例。所有病例均给予物理降温、镇静、降颅压等常规治疗,纳洛酮组在常规治疗基础上加用盐酸纳洛酮,按0·03mg/kg,每天2次连续使用5d。治疗前后分别检测脑脊液NSE。结果纳洛酮组与常规组治疗前患儿脑脊液NSE质量浓度分别为(35·66±6·13)ng/mL;(33·83±8·80)ng/mL(P>0·05)。两组在治疗后脑脊液NSE分别为(28·20±7·48)ng/mL;(22·59±8·75)ng/mL(P<0·05)。纳洛酮组治疗后脑脊液神经元特异性烯醇酶有显著下降(P<0·05),常规组脑脊液神经元特异性烯醇酶改变差异无显著性(P>0·05)。治疗组在意识障碍恢复方面明显好于常规组;治疗组恢复期失语、呆滞出现情况显著减少(P<0·05)。结论纳洛酮治疗后短期可以使重型流行性乙型脑炎脑脊液NSE含量明显下降,纳洛酮有减轻重型流行性乙型脑炎脑损伤的作用,利于病情恢复。
Objective To study the changes and clinical significance of cerebrospinal fluid neuron-specific enolase (NSE) in children with severe Japanese encephalitis who received naloxone. Methods A total of 48 children admitted to Department of Infectious Diseases, Yuying Children’s Hospital Affiliated to Wenzhou Medical College from June 1999 to June 2006 were divided into naloxone group (n = 28) and routine group (n = 20). All cases were given physical cooling, sedation, reducing intracranial pressure and other conventional treatment, naloxone group on the basis of conventional treatment with naloxone hydrochloride, according to 0 · 03mg / kg, 2 times a day for 5d. Before and after treatment of cerebrospinal fluid were detected NSE. Results The concentrations of NSE in cerebrospinal fluid (n = 35,66 ± 6 · 13) ng / mL and (33 · 83 ± 8 · 80) ng / mL were significantly higher in naloxone group and conventional group before treatment (P> 0.05) . The CSF NSE of the two groups were (28.20 ± 7.84) ng / mL and (22.59 ± 8.75) ng / mL, respectively (P <0.05). Cerebrospinal fluid neuron-specific enolase was significantly decreased after naloxone treatment (P <0.05), while there was no significant difference in routine neuron-specific enolase (P> 0.05). The treatment group was significantly better than the conventional group in the recovery of consciousness, and the treatment group had aphasia and sluggish recovery in the recovery phase (P <0.05). Conclusion Naloxone could decrease the NSE content in cerebrospinal fluid in patients with severe Japanese encephalitis in a short term after treatment with naloxone. Naloxone can reduce brain injury in patients with severe Japanese encephalitis, which will benefit the recovery of the disease.