目的观察盐酸纳洛酮联合正中神经电刺激对脑出血昏迷患者脑血流及电生理变化的影响。方法 66例脑出血昏迷患者随机分为试验组33例和对照33例。对照组静脉滴注盐酸纳洛酮4 mg和5%的葡萄糖250 m L,每天1次。试验组在对照组的基础上联合正中神经电刺激进行治疗,2组疗程均为1个月。比较患者治疗前后脑血流、电生理、脑水肿、脑出血、格拉斯哥昏迷(GCS)评分变化,评价2组患者的临床疗效和安全性。结果试验组的基底动脉血流速度为(95.35±8.21)cm·s~(-1),大脑中动脉血流速度为(39.35±6.03)cm·s~(-1);对照组基底动脉血流速度为(82.35±7.84)cm·s~(-1),大脑中动脉血流速度为(32.32±5.18)cm·s~(-1),差异有统计学意义(P<0.05)。治疗后,试验组脑干听觉诱发等级为Ⅰ、Ⅱ级分别为24.24%(8/33例),51.51%(17/33例),对照组分别为9.09%(3/33例),36.36%(12/33例),差异有统计学意义(P<0.05)。试验组脑电图等级为Ⅰ、Ⅱ级分别为30.30%(10/33例),51.52%(17/33例),对照组分别为12.12%(4/33例),21.21%(7/33例),差异有统计学意义(P<0.05)。试验组的脑血肿量为(19.21±3.15)mL,对照组为(26.32±4.36)mL;试验组GCS评分为(13.57±2.04)分,对照组为(11.24±1.75)分,2组差异有统计学意义(P<0.05)。试验组总有效率为93.94%(31/33例),对照组为72.72%(24/33例),差异有统计学意义(P<0.05)。药物不良反应主要表现为恶心、呕吐,试验组药物不良反应发生率为12.12%(4/33例),对照组为9.09%(3/33例),差异无统计学意义(P>0.05)。结论盐酸纳洛酮联合正中神经电刺激能明显改善脑出血昏迷患者的脑血流、电生理、脑血肿及昏迷情况,临床疗效较好,安全性高。 Objective To observe the effects of naloxone combined with median nerve stimulation on cerebral blood flow and electrophysiological changes in patients with cerebral hemorrhage and coma. Methods Sixty-six patients with cerebral hemorrhage coma were randomly divided into experimental group (33 cases) and control group (33 cases). In the control group, 4 mg of naloxone hydrochloride and 250 mL of 5% glucose were intravenously administered once a day. The experimental group was treated with median nerve stimulation on the basis of the control group, and the two courses of treatment were all 1 month. The changes of cerebral blood flow, electrophysiology, cerebral edema, cerebral hemorrhage and Glasgow coma (GCS) score before and after treatment were compared to evaluate the clinical efficacy and safety of the two groups. Results The basilar artery blood flow velocity was (95.35 ± 8.21) cm · s ~ (-1) in the experimental group and (39.35 ± 6.03) cm · s ~ (-1) in the middle cerebral artery. The basilar arterial blood The flow velocity was (82.35 ± 7.84) cm · s ~ (-1) and the middle cerebral artery blood flow velocity was (32.32 ± 5.18) cm · s ~ (-1), the difference was statistically significant (P <0.05). After treatment, the levels of brainstem auditory evoked by the experimental group were 24.24% (8/33) and 51.51% (17/33), respectively, while those in the control group were 9.09% (3/33) and 36.36% (12/33 cases), the difference was statistically significant (P <0.05). The electroencephalogram grade I and II in the experimental group were 30.30% (10/33) and 51.52% (17/33) respectively, while the control group was 12.12% (4/33) and 21.21% (7/33 Cases), the difference was statistically significant (P <0.05). The cerebral hematoma volume in the experimental group was (19.21 ± 3.15) mL and that in the control group was (26.32 ± 4.36) mL. The GCS score was (13.57 ± 2.04) in the experimental group and (11.24 ± 1.75) in the control group, Statistical significance (P <0.05). The total effective rate was 93.94% (31/33 cases) in the experimental group and 72.72% (24/33 cases) in the control group, the difference was statistically significant (P <0.05). Adverse drug reactions were mainly nausea and vomiting. The incidence of adverse drug reactions was 12.12% (4/33 cases) in the test group and 9.09% (3/33 cases) in the control group, with no significant difference (P> 0.05). Conclusion Naloxone hydrochloride combined with median nerve electrical stimulation can significantly improve cerebral blood flow, electrophysiology, cerebral hematoma and coma in patients with cerebral hemorrhage and coma, and has good clinical efficacy and high safety.