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Curative

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Curative

    Curative

    ?

    82e.(啦触Ed/t~n)2002;5(2):82.85

    CurativeeffectofwilsoniiinjectaoffsevereheadiIlil-nf

    CHENLigang陈礼剐.ZENGFanjtm曾凡俊,YANGLibin杨立斌.CHAIJiamkang柴建,uKaihui李开

    ,LUMin卢敏andKUANGYangqin匡永勤

    Obsk,et/reTostndythecurativeeffectofwUso~ tnjectaoosevereheadinjury(sin).

    Methods:Atotalof120lmfieetswithSH1wees dSvtdedrandomlyinto2groups,thepatientstreatedwith conveatlanalmethodsGroupA(n=60)aadthepatients treatedwithwilsoniii~ectaGroupB(it=60).The

    chllofBeura[flmctj0nindexeswereevaluatedwith GlasgowComaScale(GCS)beforetreatmentandwith GlasgowOutcomeScale(COS)tertreatment, slultanmuslythelmrametersofhemoeoIogiindexes

    (HI),brainelectricalacav~ymap(BEAM)and transcramialDopplersonography(TCD)were0 beforeaad91[~eFtreatment.

    ResortsInGroupB.theclinkalGCStheHI.the BEAMtheprognosisGEtS1NelN~lmpmvedmeshm

    S豢篙

    electricalactivitymap(BEAM),transcranialDoppler sonography(TCD)andGlasgowOutcomeScale(GOS) Patienb

    AllthepatientswithSH1werehospitalizedinour

    departmentfromJuJv1997toDecembet1998.The patientssufferedfromclosedinjuryofbrainforless than6hours,theiragesrangingfrom18to60years andtheirGCSscoringfor3-8.Pregnancywomen, DepartmentofNeurostLqgery,Genera].HospitalofcIleu MilitaryCommand,Chengdu610083.China(ChenLG,Zeng FJ,YangLBChaiJK,LiKH,LaMandKuangYQ)

    *Ccxespondingauthor:Tel:0286570523

    i

    thanthose_GroupA.AndtheTCD哪岫—I_G.p

    BdIre蚺酣,had6nt蛳哪咖md

    withthatiaGroupAfPO.01).

    Con~:W~mnli.je出咖拜idl,the

    uredpersons'_sstates,the?瑚.IBEAMand

    thesurvivingqly.It鲫翻杠ththeimmtof

    the?-reltothereIjefotthe0岬眦otthe

    arterialbloodregalsinlhebrain,wbldabe0neotthe

    In哪啊协tm.chllotwllsanfiieh.岫咖劬喀the

    progn~.

    Keyw珊证?e.dI;u阳瞳帅曲啊hy,

    Dopplertr棚坤In|aI;??rIe0lo;Brimg;

    Wilso~吣曲

    ChinJTmumatol(EngEa)2002;(2):82-85

    breastfeedingwonlell,patientswith8evel~primary diseases,patientswithpsychonosemaoFpatientsin vegetablelivingstatewereeliminatedoutofthe experiment.Thesuitablepatientsweredealtwith operationsorwithemergencytreatmenttomakethe patientsreachs【朗dvcondition.At3daysafterinjury, thepatientswererandomlydividedinto2groups.the

    conservativelytreatedgroup(GroupA,n=60)and thewilsoniiinject~treatedgroup(GroupB,n=60). Theclinicalfeaturesofthetwogroupshadnoob~ians difference(P>0.05.Table1).

    Treatment

    ThepatientsinGroupAweredealtwith

    dehydration,holTooneandantiinflammation.After

    beingdealtwiththe$~nlemethodsasthepatientsin GroupA,thepatientSinGroupBwefedealtwitll60 mlwilsoniiinjecta(ChineseUSAJointWusulijiang

    PharmaceuticalCo.Ltd.Heilongjiang)addedin5% glucoseinjectionOTnormalsalinethroughlii~tYenoL1B driponceeveryday,10daysa98c0Ilr?oftrealment.

    andgoingthesecondCOl2J'seafter4days. GCSevaluationandHI,BEAMandTCD

    measurement

    PeriedicrecordsofGCS,HI,BEAMand1?D

    measurementweremadeat3daysafter.mjmybefore ,

    ?氨;

ChineseJournalofTraumato~"(EnglishEdition)2002;5(2):8285?83?

    entofw?son::;n:ecta.HI:ncludedth.pl~ma v_city(),hematocrit(HCT),erythrocyte aggregationindex(EAI)anderythrocytesedimentation rate(ESR).InBEAM,thepowerchangesof6,,p

    andQwaveswereobsercedandevaluatedmainly.That onephenomenonoccurredasfollowingCOUIdbe consideredabnormal,partpowerof6wavehierthan Grade5.powerof0wavehisherthanGrade6and

    distributinginparLregionorinallthebrain,Bwave distributinginbethhemispheresasymmetricallyand parthigherthanGrade2,orawavedistributing asymm~"icallyandhigherthanGrade2orthetotal powerincreasingby4grades.Andtheabnormalityrate ofBEAMwascalcu~tedinthepatien~inbothgroups. InTcD,thebloodflowrate(Vs)ofarterialbloodin systole,theaveragebloodflowrate(Vm)andthe pulantilityindex(PI)inthebrainwereobserved. Pr010evalualionandstatisticanalysis

    TheprognosiswiltsevaluatedwithGOSafterbeing followedupfor6mortths.Thedatawereexpressedas ?sandStudent's?testwasemployedinthisstudy.

    APvalue<0.01wasconsideredillssignificant drenc~.

    RESU1S

    GCSs?

    TheaverageGCS8COl~Sbeforetrealment,after thefirstcouleeandafterthesecondcouleeoftreatment on30patientsinGroupBwere4.98,10.6(P< 0.01.ompwIbt~atmgnt)dl4.j

    (P<0.[301.comparedwiththatbefore~eatment), respeetively.andtheywere5.01,8.9and10.1, respectively,inGroupA.Thereexistedsignificant differenceofGGSSCOFeSbetwe@nGroupBandGroup Aafterthetwoc0ursesoftreatment(P<0.01). ChangesofHI.BEAMandTCD

    ThechangesofHIBreshowninTable2.Tbe

    abnormalityratesofBEAMwere93.8%(27eases)in 60casesinGroupBbeforetreatment,70.1%(19

    cases,P<0.O1)afterthefirstcouiseand37.2%(8 cases.P<0.001)afterthesecondeoniseof treatment,buttheywere94.2%.90.8%and

    79.2%,respectively,inGroupA.nreexistedno significantstaffsticdireneeoftheabnorlllallratesof BEAMinthesflln.egroup,butthereexistedstatistic drenceafterthefirstco1118~andthesecondcourse oftreatmentinGroupBandGroupA(P<0.01). TheoutcomesofTCDexominationinbothgronpsare showninTable3.

    Prognosisevaluation

    ThereweTe25ease8(83.3%)recoveredoronly disabledmildlyinGroupB,and9(30.0%)inGroup A,whichmeantsignificantdifferencebetweenthetwo groups(P<0.O1).erewere5c跚吕(16.7%)

    disabledmoderatelyorseverelyinGroupB.and21 (70.0%)inGroupA,whichalsomeantsignificant diffefencebetweenthetwogroups(P<0.01). Table1?Clinicalfeaturesofpafien~intwogroups C,roupsnTimepomts(raKP.)HCT(%)EMEs(m)

    P(0-01Comparedthat0fGc~mpAatthesamtimeI:omt ,tI4.863,l24908,t33.356,":3.526

    嚣翻l赫霾

    84.mM0f0(EnglishEdition)2002;5(2):82-85 *P'001eompm'e6-~iththatGroup^theetimepointr;L:3458,t2:3388,t3:3.395 DIsCUSS0N

    Theaimofphasmacotherapyistopreventthe occurreoceandalleviatethesituationofsecondary braininjury.becausesecondaD'braininjurywill

    direcdyinfluencetheimprovementoferaniocerebral injury.Cerebralisehemiaandhypoxiainducevarious secondarypathologicali~ufies.Blood-brainbarrier, excitatoryaminoacid,oxygenfreeradical,ion channel,internalfluwofintracellulurcalciumionand genechangearefromthefunctionalandorganic changesofmicroeiroulation,neLl/onmembranesystem andthereceptors,andcellorganellesespeciallythe ehondriosomeinducedbybraininjuryandischemia andhypoxiaofneuraltissues,whichcaninduceor aggravatecerebraledemafurther.Theformationof mierothrombus,microcimulafiondysfunction,cerebral ischemiaandhyperviseositysyndromeinbloodofthe wholebodycanaffectthebloodpeffusionofcerebral tissuesandaggravatemicrocirculationdysfunction, cerebralhypoxiamadischemia.Therefore.tlIeaimof primary.treatmentf0rseveretraumaticbrain'mjuryisto preventandtreatregionalorwholecerebralischemia. Loweringtheintracranialpressure,improvingthe cerebralperfusionpressure(CPP)andimprovingthe cerebralbloodflow(CBF)areimportantmethodsto treatSHI.

    witsoniiinjectaisthestefilizedsolutionmadeby thestemandhayesofwilsoniiwithroutinemethods. Themainchemicalcompositionisisotaiin,G.sitesterol, can'otglucoside,fraxin,lilacresinenzymeglucoside, hyperin,adenosineandtotalflavone,etc.Sowilsonii injectahastheeffectsofclearingtheoxygenfree radicals,improvingobviouslytheactivityofsuperoxide dismutese(SOD)inhumanbody,loweringtheblood

    viscosity,dilatingthecerebralbloodvessels, increasingthecerebralbloodflow,acceleratingthe bloodcirculation,increasingtheoxygensaturationof bloodincerebralcellsandstrongthenirgthe immunologicalfunctionofthebody.'.T11isstudv provesthatthebloedviscosityinclP..asesobviouslyand continuesfuralongtimeafterSCI,especiallyHCTand EAIincreasingmestobviously.Butafterbeingtreated withwilsonii_mjecta,theindexesof1b,HCT,EAI

    andESRofthepatientsinGroupBdecreasedmore obviouslytllanthoseinGroupA(P<0.O1).And clinicalstudyshowstheGCSseol'l~inGroupB increasedsignificandy(P<0.O1).ThoughtheGCS score8aisoinereasedinGroupA,thereisnostatistic dirence.AftertwoCOllr$~softreatmentofwilsonii injecta,theabnormalityrateofBEAMdecreased obviously(from93.8%beforetreatmentdecreasingto 37.2%afterthesecondcourse.P<0.O1).Andthe GOSonprognosisshowswilsonfidoescontributetothe recoveryofcerebralfunctionafterSCI,andCall improveob~iouslytheGCS.BEAMandCOs.We

    thinkthatwilsoniiinjectacanimprovethecerebral~ microclrculationperfualon.roctthedisorderofcell morphology,functionandmetabolisminducedby isehemiaandhypoxia.andallev'tecerebraledema

    andsecondarybraininjury,soastoprotectthe cerebralcellstoobtainactiveandrealcurativeeffect forpatientswithSCI.

    Someresearchelfoundthatthechangesof

    cerebralhemodynamiesafterSCICallbedividedinto

lowpetfusianstage(1-24hours),congestivestage(1

    3days)andcerebralvasespasmstage(414days).

    TCDmonitoringfindsthatnimodipineCallimprovethe cerebralvasospasmafterIrauma,andcanlowerthe mortality-anddisabledrateofthepailentswith traumaticsubarachnoidhemorrhage..Thechangesof TCDmonitoreddynamieallyshowthatVs.VmandPI decreasedsignificantlyat2weeksaftertrealmentof wilsoniiinjeeta(P<0.O1).ThoughVsVmandPI alsodeereasedinthecontrolgroup,thereisnostatistic significance(P>0.05;).Simultaneously.thereexists

ChineseofTraumawlogytEnglishEd~ion)2?2;5(2)}828585

    statisticsignificanceofVs.VmandPIinbothgroups tP'O.O1),whichmayberelatedtotheeffectof tim.oneinwilsoniiinjects.indilatingcerebralblood vesselsandrelievingthecerebralvaaospasm.It suggeststheearlytreatmentofwilsoniiCal1.irapmvethe middlecerebralartery.

    (MAC)bloodspeed,lowerthe

    cerebralvascularresistance,improverapidlythe "/a,~ospasmafterbraininiurvandthesecondarycerebral edema.cerebralsweujngandtheincreasedintracranial pressureinducedbycerebralischemiaandhypoxia.s0 asto1owetthemoltalityanddisabledrate.whichmay beoneoftheimportantmechanismsofthegoodeffect ofwilsoniiiniectaonSCI.

    1YiSY.SettleofkeypmMemsabouttreatmentforsevere headinjuryChinJNeurosurg1999;15:3_6.

2.GermadleTA,SpielmanGM,La,gfi,TW,eta1.

    Influe~weofthetypeofinttacratfiallesion.noutcomefrom vereheadinjuo,:amulficemricstudyusinganew classificatlonsystem.JNetrrosurg1982;56:26-32. 3.RobertsonLDenaturation~pisalesafterseverehead iniL?v:iofi_uenceO13.outc~nle.ActaNeurt~hirl993;59:98-101. 4.1jXY.WangZC.NewadVKlsceofIxeiRlnentfor traumaticeraniocerebraljnjy.ChinJN~urg1999;15:55- 57.

    5.lYz.CaiH,YuN,etI.CHniellevahati~aof

    wilsoniiiectaOncerebralhemorrhage.JT1tCnMed 1998:39:214-217.

    6.ChinesePharmaceutiealInstituteofMedicalscienceB. TraditionalChineseMedicine.1sled.Bing:People's

    PublishingHouse0fHygiene.1993:462-468.

    7.MartinNA,PatwardhanRv,喧咖Mj,eta1.

    CharacteristicsofcerebralhemodynamicpllltSe$followingsre headtrauma'hypopeffusion,hyperemiaandvasos~m.J Neurosurg1997;87:9-19

    8.HardersA,KakariekaA,BraakmanR.eta1.

    TraunmficsubarachnoidhemorrhageanditrBslln~twith nimodlpin~JNe~osutg1996;85:82-89.

    (Received20,2001)

    EditedbyLIUYang'e

    一鞠霭圈_

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