| 摘要: |
| 目的 探讨发作性交感神经功能亢进(PSH)的临床特征、治疗方法及预后。方法 采用前瞻性研究方法,对第二军医大学长征医院神经外科2011年月至2014年3月收治的临床诊断为PSH的患者进行综合分析,筛选A组和B组患者各24例。在一般治疗和高压氧治疗的基础上,A组首选普萘洛尔、加巴喷丁、苯二氮(艹卓)类药物联合治疗,B组以冬眠疗法作为对比。记录患者临床特征,比较病例特点及2周时治疗效果,并以12个月时患者格拉斯哥昏迷指数(Glasgow Coma Scale, GCS)及格拉斯哥预后指数(Glasgow Outcome Scale,GOS)评价患者预后。结果 PSH患者平均年龄为(27.48±9.62)岁,入院GCS评分均≤8分。A组患者住院时间(d)短于B组(206.08±28.57 vs 223.75±27.74,P<0.05),治疗2周后总发作时间(min)少于B组(170.08±79.39 vs 225.63±105.70, P<0.05)。12个月随访观察期内2例失访(均为A组),余46例患者中,A组GOS评分优于B组(P<0.05)。存活的40例患者(A、B两组各20例)中,两组GCS差异无统计学意义。结论 PSH多见于年轻患者,往往颅脑损伤较重,需要尽早药物干预。以普萘洛尔、加巴喷丁等药物为主的治疗方法可一定程度改善PSH患者的预后,在缩短住院时间、提高患者生存状态方面优于冬眠合剂治疗。 |
| 关键词: 发作性交感神经功能亢进 颅脑损伤 药物治疗 前瞻性研究 |
| DOI：10.3724/SP.J.1008.2015.00675 |
| 投稿时间：2015-05-15修订日期：2015-06-04 |
| 基金项目:国家自然科学基金(81371382,81271350). |
|
| Clinical characteristics and treatment strategy of paroxysmal sympathetic hyperactivity |
| QI En-bo,LÜ Li-quan,WANG Jun-yu,CHEN Wen,GU Jin-mao,GONG Shun,HOU Li-jun* |
(Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding authors) |
| Abstract: |
| Objective To study the clinical characteristics, treatment methods and prognosis of the paroxysmal sympathetic hyperactivity (PSH). Methods We comprehensively analyzed 48 patients diagnosed with PSH from the neurosurgery department of Changzheng Hospital in Shanghai using a prospective study design. The patients were divided into two groups according the treatments they received. In addition to general treatment and hyperbaric oxygen treatment, patients in group A were mainly given propranolol, gabapentin, and benzodiazepines combined therapy, and those in group B received hibernation therapy as controls. The clinical characters, case characteristic, and treatment effect after two weeks of treatment were recorded and compared. Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores were used to evaluate the prognoses of patients after 12 months. Results The average age of the PSH patients was (27.48±9.62) years old, with the GCS score ≤ 8 at admission. The treatment group (group A) had a shorter hospitalization time ([206.08±28.57] d vs [223.75±27.74] d, P<0.05) and a shorter episode time after two weeks' treatment ([170.08±79.39] min vs [225.63±105.70] min, P<0.05) compared with the control group. Two patients in group A were lost in the 12 months follow-up. The GOS score of group A was significantly better than that of the control group (P<0.05). The GCS scores were not significantly different between the 40 survived patients in the two groups (20 in each group). Conclusion PSH is commonly seen in young people suffering severe traumatic brain injury, who require early drug treatment. Propranolol combined with gabapentin treatment can improve the prognosis of patients, and it is superior to artificial hibernation by shortening hospitalization time and improving patient survival. |
| Key words: paroxysmal sympathetic hyperactivity craniocerebral trauma drug therapy prospective studies |
