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尽管GCS给临床提供了有用的预后指标,但对低分患者的可靠性较差。由于交感神经系统参与应激反应,且随着创伤的严重度和预后变化,其反应亦相应有别。故作者对伤后48小时内的61例创伤性脑损伤患者测定了血浆儿茶酚胺类(CA’s)的浓度,观察能否作为一种内源性指标以预测患者的病残率和死亡率。结果伤后48小时内CA’s的平均浓度与GCS密切相关,在有严重(3-4分,21例)、明显(5-7分,14例)、中度(8-11分,14例)和轻度神经功能异常的患者间有显著差异。GCS为3-4分组,正肾上腺素(NE)和肾上腺素(E)4-5倍于多巴胺(DA),2倍于高分组。无瞳孔反应者,CA浓度明显高于有瞳孔反应者。任何一种CA与颅内压无关。入院时GCS为3-4分的21例患者,CA浓度与伤后1周的结局有关。凡NE在1300pg/ml以上者,有
Although GCS provides a clinically useful prognostic indicator, it is less reliable for patients with low scores. As the sympathetic nervous system involved in stress response, and with the severity of trauma and prognosis, the response is also different. Therefore, the authors measured the concentration of plasma catecholamines (CA’s) in 61 patients with traumatic brain injury within 48 hours after injury and as an endogenous index to predict the morbidity and mortality of patients. Results The average concentration of CA’s within 48 hours after injury was closely related to GCS, with significant (3-4 points, 21 cases), significant (5-7 points, 14 cases), moderate (8-11 points, 14 cases) There was a significant difference between patients with mild neurological dysfunction. GCS was 3-4, 4- and 5-times more epinephrine (NE) and epinephrine (E) than dopamine (DA), and twice as high. Without pupil responders, CA concentrations were significantly higher than those with pupil responders. Any CA has nothing to do with intracranial pressure. 21 patients with a GCS score of 3-4 on admission were associated with a 1-week outcome. Where NE above 1300pg / ml, there