中西医结合治疗重型颅脑损伤并发应激性溃疡疗效观察

2015-03-12杨晓峰刘兴河山东省临邑县中医院山东临邑251500

实用中医药杂志 2015年10期

杨晓峰，刘兴河（山东省临邑县中医院，山东　临邑　251500）

杨晓峰，刘兴河
（山东省临邑县中医院，山东临邑251500）

［摘要］目的：观察中西医结合治疗重型颅脑损伤并发应激性溃疡的效果。方法：60例随机分为治疗组和对照组各30例，两组均予以西医治疗，包括胃内注入去甲肾上腺素冰盐水、注射立止血、奥美拉唑等，治疗组加用生大黄粉胃管内注入治疗。结果：治疗组总有效率96.7%，显效率70.0%；对照组总有效率86.7%，显效率43.3%。两组显效率和总有效率比较差异有统计学意义（P＜0.05）。结论：中西医结合治疗重型颅脑损伤并发应激性溃疡疗效好。

［关键词］重型颅脑损伤；应激性溃疡；中西医结合；对照治疗观察

［Abstract］Objective：To observe the effect of the combination of TCM and western medicine in the treatment of severe craniocerebral injury complicated with stress ulcer. Method：60 cases were randomly divided into two groups evenly. The control group received western medicine treatment，including intragastric injection of noradrenaline in ice water，Reptilase，omeprazole etc while the study group were treated with rhubarb powder stomach tube injection based on western medicine treatment. Result：The total efficiency of the treatment group was 96.7% and the effective rate was 70% while that of the control group was 86.7% and 43.3% respectively. The efficiency of the treatment group and the total effective rate was significantly higher than that of the control group and there was significant efficiency and total efficiency difference in the two groups（P＜0.05）.Conclusion：Combination of TCM and western medicine has good therapeutic effect on severe craniocerebral injury with stress ulcer.

［Key Words］Rhubarb powder；Severe craniocerebral injury；Stress ulcer; combination of TCM and western medicine; Control treatment and observation

应激性溃疡是重型颅脑损伤患者常见的并发症，治疗方法除了积极治疗原发病外，主要是抑酸、止血等对症治疗。临床上用于止血的药物较多，2010年10月至2014年9月，我们用生大黄粉配合西药抑酸、止血等治疗重型颅脑损伤并发应激性溃疡60例疗效满意，现报道如下。

1　临床资料

60例均为本院重症医学科住院重型颅脑损伤患者，均有明确头部外伤史，其中交通伤54例，坠落伤4例，打击伤2例。入院时GCS＜8分，均经头颅CT检查确诊，其中硬膜下血肿并脑挫裂伤40例，弥漫性轴索伤10例，脑挫裂伤6例，多发性脑内血肿2例，硬膜外血肿2例。随机分为两组。治疗组30例，男17例，女13例；年龄18～76岁，平均46.8岁。对照组30例，男16例，女14例；年龄18～76岁，平均46.2岁。两组性别、年龄、受伤方式及GCS评分经统计学处理无显著差异（P＞0.05），具有可比性。

诊断标准：①近期内无消化道疾病，既往无上消化道出血史；②无严重肝、肾疾病；③入院前1个月未服用解热镇痛药、肾上腺皮质激素和神经系统药物；④颅脑损伤后出现呕血、黑便等症状或胃液、粪便潜血试验阳性（排除颅底骨折及口鼻腔出血被吞咽）。