目的:探究安宫牛黄丸治疗重型颅脑损伤(STBI)的神经保护作用及对肠黏膜通透性的影响.方法:选择STBI病人180例作为研究对象,按照随机数字表法分成观察组和对照组,各90例,其中对照组病人采取常规药物治疗,观察组病人在对照组治疗的基础上采用安宫牛黄丸治疗.比较2组病人治疗前和治疗后5d、10 d时格拉斯哥昏迷评分、血清神经元特异性烯醇化酶(NSE)水平、白细胞介素(IL)-6水平、乳果糖排泄率和血浆二胺氧化酶水平变化情况,分析2组病人临床疗效和并发症发生情况.结果:观察组病人治疗总有效率为95.6％,高于对照组的80.0％(P＜0.05);观察组治疗后5d和治疗后10 d的格拉斯哥昏迷评分明显高于对照组(P＜0.01),血清NSE水平和IL-6水平均明显低于对照组(P＜0.01);观察组治疗5d和10 d的乳果糖排泄率和血浆二胺氧化酶水平均明显低于对照组(P＜0.01);各项并发症发生率均低于对照组(P＜0.05～P＜0.01).结论:安宫牛黄丸可以有效降低STBI病人血清NSE含量及IL-6水平,抑制机体炎症反应,并能明显改善病人肠黏膜通透性,促进病人受损神经和胃肠黏膜功能恢复.%Objective:To explore the neuroprotective effects of Angong Niuhuang pill in severe traumatic brain injury (STBI) patients,and its effect on the permeability of enteric mucosa.Methods:One hundred and eighty patients with STBI were randomly divided into the control group and observation group(90 cases each group).The control group was treated with conventional drug,and the observation group was additionally treated with Angong Niuhuang pill based on the control group.The glasgow coma scale score,serum levels of neuron-specific enolase,IL-6 and diamine oxidase,and lactulose excretion rate between two groups before treatment and after 5 and 10 days of treatment were compared.The clinical effects and incidence rate of complication were analyzed.Results:The total effective rate in observation group (95.6％) was higher than that in control group (80.0％) (P ＜ 0.05).After 5 and 10 days of treatment,the scores of glasgow coma scale in observation group were significantly higher than those in control group (P ＜ 0.05),and the serum levels of neuron-specific enolase,IL-6 and diamine oxidase,and lactulose excretion rate in observation group were significantly lower than those in control group(P ＜ 0.01).The incidence rate of complications in observation group after treatment was significantly lower than that in control group(P ＜ 0.05 to P ＜ 0.01).Conclusions:Angong Niuhuang pill can effectively decrease the levels of neuron-specific enolase and IL-6,inhibit the inflammatory reaction,improve the permeability of enteric mucosa and promote the function recovery of the injured nerve and enteric mucosa in STBI patients.
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