医药学论文：脑外伤急性期一氧化氮的变化和意义[1]

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关键字：患者 变化 细胞 作用 升高 缺血 外伤 峰值 毒性作用 伤情
　　摘要　目的　探讨一氧化氮(NO)在脑外伤急性期的变化及意义。方法　用Griess试剂测定脑脊液中NO含量。结果　脑外伤急性期NO峰值高于对照组(t=2.834,P＜0.01)；重伤组NO动态监测时，其峰值(10.872±9.231)μmol/L出现于伤后24 h内，48～72 h再次升高为(6.577±5.720)μmol/L,而轻伤组仅出现于48 h内，为(6.470±5.886)μmol/L;预后不良组NO峰值高于良好组(t=2.313,P＜0.05)。结论　脑外伤急性期NO有不同程度的升高，伤情越重，升高越明显，预后也越差。NO与临床指标的结合将提高对颅脑损伤的程度和预后判断的准确率。

　　Objective　To investigate the changes and significance of nitric oxide (NO) following brain trauma at acute stage.Methods　The value of NO was determined by Griess reagent in cerebrospinal fluid of patients with acute brain-injury and was analyzed by combining with clinical index.Results　The peak value of NO was significantly higher in the brain-injured group than that in the control group, P＜0.01; in severe group, NO peak value appeared within 24 hours, declined within 24-48 hours, and increased again from 48 to 72 hours; but in mild group, NO peak value appeared within 48 hours; the value of NO was higher in the poor prognostic cases than that in the&nb sp;good ones, P＜0.05.Conclusions　NO has different increases following acute brain injury, the severer the traumatic severity, the higher NO increases, and the poorer the outcome becomes. When NO level is combined with clinical index, the accuracy of judging the severity of brain injury and the outcome, prognosis will be improved.

　　Key words　brain trauma; nitric oxide; traumatic severity; prognosis

　　研究表明，一氧化氮(nitric oxide, NO)是一种新型的神经递质，在神经系统中起重要的病理生理作用。而人类脑外伤后NO的变化和意义尚不清楚。本文报道通过对38例脑外伤患者脑脊液中NO含量测定并结合一定的临床指标，探讨脑外伤急性期NO的变化情况及其与伤情、预后的关系和临床意义。

　　1　材料和方法

　　选择38例脑外伤患者(男35例，女3例)，年龄18～70岁，均系伤后24 h内入院，CT诊断明确，无明显合并伤，伤前无心脑血管疾病和严重感染病史。根据格拉斯哥昏迷评分(GCS)，将患者分为GCS＞8分组计15例和GCS≤8分组计23例。入院后开颅手术治疗25例，非手术治疗13例。按3月后格拉斯哥结果评分，分为预后良好组22例(良好17例，中残5例)和预后不良组16例(重残5例，植物生存3例，死亡8例)。对照组为10例健康成人。

　　术后行颅内压监护者，脑室穿刺时采样1次，以后每24 h采集脑脊液1次，共3～7次；非颅压监护者或非手术者于伤后24 h内腰穿测压，谨慎操作，如颅压高，经脱水处理后采样1次。采样量2～6 mL,即刻离心，2500 r/min,15 min。上清液保存于-70℃冰箱内待测。用Griess试剂间接测定N医药学论文