| Purpose: To evaluate the efficacy of nalmefene combined with hyperbaric oxygen in the treatment of acute severe brain injury,and to provide evidence for the clinical diagnosis and treatment of patients with acute severe brain injury.Methods : Using the cohort study method,numbers 1-90,which are included in the study order,are randomly divided into four groups of A,B,C,and D,which will meet the inclusion criteria from October 1,2015 to October 31,2017.Ninety patients admitted to the Department of Neurosurgery at the Affiliated Hospital of Southwestern Medical University who had undergone acute craniocerebral injury and required emergency surgery entered the appropriate group for treatment in the order they were included,because 3 patients could not tolerate the treatment of hyperbaric oxygen and did not withdraw halfway.Including the statistics of this study,87 cases of patient data were finally included for statistical analysis.A group(conventional treatment group,preoperative and postoperative treatment for hemostasis,gastric protection,prevention of infection,prevention of epilepsy,dehydration,intracranial pressure,nutritional support,rehydration,control of blood pressure,control of body temperature,symptomatic support,blood circulation,etc.)Twenty-two patients were in Group B(normal treatment plus nalmefene),22 in Group C(normal treatment plus hyperbaric oxygen treatment group),and 20 in Group D(normal treatment plus combined nalmefene and hyperbaric oxygen therapy).The double-antibody sandwich enzyme-linked immunosorbent assay(ELISA)was used to detect the NSE and S100 B protein concentrations of the enrolled patients at the time of admission and on the 1st,2nd,3rd,5th,7th,10 th,and 14 th days after admission;All patients included in the study were evaluated on the GCS score(Glasgow Coma Scale)at admission,3 days postoperatively,7 days postoperatively,and 14 days postoperatively;GOS was assessed at 3 months postoperatively(Glasgow Outcome Score)The patient was evaluated for prognosis,and the occurrence of pulmonary infections,deaths,and the occurrence of adverse reactions related to nalmefene and hyperbaric oxygenation were recorded.Twenty healthy people aged 18-60 years were used as healthy control group E to measure their serum NSE and S100 protein expression levels.Results:(1)The P value of the statistical analysis of the selected patients’ age,male/female ratio,admissions condition(GCS),and injury factors were all> 0.05,and there was no statistical difference in the baseline data of the selected patients.Good;(2)Comparison of GCS scores at 14 days after surgery in four groups of patients.The overall GCS scores of patients in groups B,C,and D at 14 days after surgery were significantly higher than those of group A in conventional treatment.Differences in learning(P<0.05);There was no significant difference in the GCS scores between group B and group C after 14 days(P>0.05).The GCS scores of group D were significantly higher than those of corresponding points at 14 days after surgery.The GCS scores of the two groups were statistically significant(P<0.05);(3)The GOS scores of the four groups were compared: The effective rates of the four groups of patients A,B,C,and D increased in turn.50%,65.2%,68.2%,and 80%,respectively,of the GOS prognostic scores between group A and group D,with statistically significant differences(P<0.05).The remaining GOS prognoses scores were compared with each other(groups A and B,There was no significant difference between group A and group C,group B and group C,group B and group D,group C and group D(P>0.05);(4)Mortality comparison between the four groups: A,B The deaths of patients in groups C,D,and C were all 2 weeks after surgery.The causes of death were mostly pulmonary infections resulting from long-term bedridden and poor nutritional status.Mortality was reduced in turn,with a mortality rate of 22.7% in the four groups.17.4%,13.6%,and 10.0%,there was no statistical difference in the mortality rate among the four groups(P>0.05);(5)The rate of lung infection in the four groups A,B,C,and D decreased in turn and they were 54.5 respectively.54.5%,34.8%,36.4%,20.0%.There was significant difference between group A and group D(P<0.05).The difference between the other two groups(groups A and B,group A and group C,group B respectively).There was no significant difference between group C,group B and group D,group C and group D(P>0.05);(6)The concentrations of NSE in patients A,B,C,and D were all at 1 The day peaked and then gradually decreased over time;the NSE concentrations at each time in the four groups were compared with those in the healthy E group.Analysis of variance was used for statistical analysis,with the exception of the DSE group 14 days after the NSE concentration,and the healthy E group.The NSE concentrations were statistically different(all P<0.05);there was no significant difference in NSE concentrations between the four groups at admission(P>0.05);A and B patients The differences in NSE concentrations between the groups at 1 day,2 days,3 days,5 days,7 days,10 days,and 14 days after surgery were statistically significant(P<0.05);patients in group A and C were postoperative 7 The day,day 10,and day 14 NSE concentrations were statistically different(P<0.05).However,there was no significant difference in NSE concentrations between the two groups on days 1,2,3,and 5(P>0.05).): There were statistical differences in NSE concentrations between group A and group D at 1 day,2 days,3 days,5 days,7 days,10 days,and 14 days after operation(P < 0.05).The NSE concentrations in group B and group C at 1 day,2 days,3 days and 5 days after operation were statistically different(P<0.05),and the two groups were 7 days,10 days and 14 days after operation.There was no statistically significant difference in NSE concentrations(P>0.05).The NSE concentrations in groups B and D were statistically comparable at days 5,7,10,and 14(ie,after treatment with hyperbaric oxygen in group D).Differences in learning(P<0.05),but there was no significant difference in NSE concentrations between the two groups on the 1st,2nd,and 3rd days after surgery(P>0.05);patients in group C and D were on days 1 and 2 after surgery.The NSE concentrations of 3 days,5 days,7 days,10 days,and 14 days were comparable.Statistical differences(P<0.05);(7)S100B concentrations in patients A,B,C,and D all peaked at 3 days after surgery,and then gradually decreased over time;S100B concentrations in the four groups at each time The comparison of NSE concentrations in healthy E group was statistically analyzed by analysis of variance(P<0.05).There was no significant difference between the four groups in S100 B concentration at admission(P>0.05);A group and B There was a statistically significant difference in the S100 B concentrations between the two groups on the 1st,2nd,3rd,5th,7th,10 th,and 14 th days after operation(P<0.05);the patients in group A and C were The S100 B concentrations at 5,7,10,and 14 days after surgery(ie,group C after hyperbaric oxygen therapy)had statistically significant differences(P<0.05),while the two groups were postoperative 1 and 2 days.There was no statistically significant difference in NSE concentration at 3 days(P>0.05): S100 B between group A and D patients at 1 day,2 days,3 days,5 days,7 days,10 days and 14 days after surgery There were statistically significant differences in the concentrations(P<0.05);the S100 B concentrations at the 1st,2nd,3rd,and 5th days after surgery in group B and C were statistically different(P<0.05).0.05),but there was no significant difference in S100 B concentrations between the two groups at 7 days,10 days,and 14 days after surgery(P>0.05);patients in group B and D had 5 days,7 days,10 days,and 14 days after surgery.The S100 B concentrations of days(ie,after the hyperbaric oxygen treatment in group D)were all statistically different(P<0.05),but there was no statistical difference in the S100 B concentrations between the two groups on days 1,2 and 3(P>0.05).>0.05);S100B concentrations in group C and D were significantly different on postoperative day 1,2,3,5,7,10,and 14 days(P<0.05).conclusions: Under close supervision,relatively stable disease condition,hyperbaric oxygen therapy can improve the prognosis of patients after severe traumatic brain injury.However,the treatment process requires skilled medical personnel to perform the treatment,and the treatment process should be closely guarded to deal with possible adverse reactions in time;2.Severe head injury Naomei Fen treatment is safe and effective,the case of nalmefene treatment in this study were no obvious adverse reactions,the overall prognosis is better than conventional treatment Group;3.Combined use of nalmefene and hyperbaric oxygen in the treatment of patients with acute severe brain injury,the prognosis is better than patients with nalmefene or hyperbaric oxygen alone,and the serum NSE and S100 B protein concentration is also more obvious. |
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