|
Objective: To explore new oxygen free radical scavenger edaravone on in patients with severe traumatic brain injury serum neuron-specific enolase (NSE) and S100B protein (S100B) concentration. Method: 1, selected from March 2009 to March 2010 after injury in Luzhou Medical College Hospital emergency neurosurgery hospital in severe head trauma 90 patients (mild head injury patients are generally not surgery, it did not included), male 62 cases, female 28 cases; aged 18 to 72 years, mean age 42.2 years old. Case inclusion criteria were as follows: (1) there is a clear history of head trauma, no other vital organs associated injuries, and all 4-8h after injury within the hospital (2) older than 17 years old, pre-injury health patients (three ) admission Glasgow Coma Score (GCS score that is) 3 'to 12', CT shows the main types of brain contusion injury and / or intracerebral hematoma and / or subdural hematoma based, with or without dural hematoma, skull fracture (4) have emergency craniotomy pointer in surgery within 12 hours after the injury. Of which 57 cases of moderate traumatic brain injury patients (GCS score 9 'to 12'); 33 patients with severe head injury (GCS score 3 'to 8'). Head CT showed: brain contusion mainly those 45 cases, 24 cases of primary intracerebral hematoma, subdural hematoma, mainly those 21 cases, with or without epidural hematoma, skull fractures. The patients were randomly divided into control group (A), post-operative application of edaravone group (B) and preoperative edaravone group (C group), each group of 30 patients, including 19 patients in group A medium-sized , 11 patients with severe, B group 20 patients with medium-sized, heavy-duty 10 patients, C group of 18 patients with medium-sized, heavy-duty 12 patients. Patients in each group underwent emergency craniotomy, surgical methods for the inactivation craniotomy brain tissue removal and / or hematoma, plus some patients decompressive craniectomy; and received at least 8d drug therapy, the treatment program: control group (A group) before and after surgery to give only the conventional treatment, including bleeding, fluid, dehydration, reduce intracranial pressure, anti-inflammatory, nutritional and other symptomatic treatment; surgery edaravone group (B) in the A group therapy Based on the first day after surgery plus edaravone 30mg, with 0.9% saline 100ml intravenous infusion after dilution, 30min completed within the drop, 2 times a day. Preoperative edaravone group (C group) in Group A treatment based on blood specimens from hospitalized immediately after the addition of serum samples edaravone 30mg, with 0.9% saline 100ml intravenous infusion after dilution once, the day after the end of surgery plus edaravone 30mg usage with preoperative intravenous infusion once, after application of edaravone group B. Group B and group C edaravone after surgery at least to 7d. While taking outpatient healthy 20 cases as a healthy control group. (2) using enzyme-linked immunosorbent assay (Enzyme-linked immunoabsorbent assay, ELISA) determination of the control group (A), post-operative application of edaravone group (B) and preoperative edaravone group (C group ) three groups on admission and after surgery, 1d, 3d, 5d, 7d peripheral blood serum neuron-specific enolase (Neuron-specific enolase, NSE) and S100B (S100B protein) concentration. While 20 healthy people measured peripheral blood serum NSE and S100B concentrations once, do healthy controls. 3, on the use of clinical data SPSS13.0 software for statistical, measurement data to x ± S said measurement data between groups were compared using ANOVA and t test, x2 test level data used to P lt; 0.05 to test significance level, respectively, each of the experimental groups compared with the control group when compared to the same time in each experimental group phase comparison, draw conclusions. Results: In normal healthy control group, serum NSE and S100B concentrations were (8.46 ± 1.05) μg / 1, (0.38 ± 0.10) μg / l. The control group (A), post-operative application of edaravone group (B), before surgery edaravone group (C group) three levels of serum NSE and S100B concentrations on admission already elevated after surgery reached a peak on day 1. On admission and after surgery 1d, 3d, 5d, 7d significantly higher than the normal healthy control group (P lt; 0.01), admission control group (A group), post-operative application of edaravone group (B group), surgery before the application of edaravone group (C group) three levels of serum NSE and S100B concentrations between pairwise comparisons were made no significant difference (P gt; 0.05). The control group (A), post-operative application of edaravone group (B), before surgery edaravone group (C group) three levels of serum NSE and S100B concentrations within the first day after surgery was significantly higher and reached a peak, and then gradually decreased as the condition improved; first day after surgery, preoperative edaravone group (C group) and control group (A) peak serum concentrations of NSE and S100B comparison, medium and heavy patients NSE and S100B concentration decreased (P lt; 0.05); preoperative edaravone group (C group) and after surgery edaravone group (B) peak serum concentrations of NSE and S100B comparison, medium and heavy patients NSE and S100B concentrations were lower (P lt; 0.05); surgery edaravone group (B group) and control group (A) peak serum concentrations of NSE and S100B comparison, medium and heavy concentrations of serum NSE and S100B not See lower (P gt; 0.05). After surgery, 3d, 5d, 7d, will be applied before surgery edaravone group (C group) and control group (A group) serum NSE and S100B concentrations compared, the results show: the heavy concentration of serum NSE and S100B reduced (P ≤ 0.02); preoperative edaravone group (C group) and after surgery edaravone group (B) Comparison of serum NSE and S100B concentrations, medium serum NSE and S100B mean concentration were lower, but not statistically significant (P gt; 0.05), serum NSE and S100B heavy concentration decreased (P lt; 0.05); surgery edaravone group (B group) and control group (A group) serum concentrations of NSE and S100B comparison, medium and heavy NSE and S100B serum concentration decreased (P lt; 0.05). Conclusions: (1) serum NSE and S100B concentrations can reflect the severity of the brain injury, the more severe the disease, elevated, the more obvious the longer the duration, in patients with acute brain injury is to determine the severity of the brain damage sensitive indicator; (2) in , severe head trauma NSE and S100B serum concentrations at admission and after surgery 1d, 3d, 5d, 7d higher than normal, suggesting that neurons and glial cells damage occurred; (3) edaravone effectively reduced in patients with severe head trauma serum NSE and S100B concentrations, the sooner the more obvious use lower, especially for patients with severe head trauma, surgery before the application of edaravone can more effectively reduce serum concentrations of NSE and S100B .
|