目的 探讨奥拉西坦联合醒脑静治疗脑外伤的临床效果及对神经元损伤的影响。

方法 选取76例脑外伤病人，随机数字表法分为观察组和对照组，各38例。在综合治疗基础上，对照组给予奥拉西坦治疗，观察组给予奥拉西坦联合醒脑静治疗。比较2组治疗前，治疗14 d、28 d后格拉斯哥昏迷评分(GCS)，急性生理和慢性健康状况评分(APACHE Ⅱ)，神经元损伤程度血清胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、钙结合蛋白S100B、髓鞘碱性蛋白(MBP)水平，神经损伤修复指标热休克蛋白(HSP)-90、HSP-70、HSP-27、神经生长因子(NGF)水平，炎症性趋化因子血清单核细胞趋化蛋白-1(MCP-1)、天冬氨酸半胱氨酸特异性蛋白酶-3(Caspase-3)、调节活化正常T细胞表达和分泌因子(RANTES)水平，预后及不良反应情况。

结果 与治疗前比较，治疗14 d、28 d后，2组GCS评分均升高，APACHE Ⅱ评分均降低，且观察组均优于对照组，差异有统计学意义( P < 0.01)，治疗28 d后评估结果显示，2组间预后优良率比较差异无统计学意义( P >0.05)；治疗14 d、28 d后，2组血清GFAP、NSE、S100B、MBP水平及血清HSP-90、HSP-70、HSP-27、NGF水平均较治疗前降低，且观察组降低幅度较大，差异有统计学意义( P < 0.05~ P < 0.01)；2组治疗14 d、28 d后血清MCP-1、Caspase-3、RANTES水平均低于治疗前，且观察组低于对照组，差异有统计学意义( P < 0.05~ P < 0.01)；2组不良反应发生率差异无统计学意义( P >0.05)。

结论 奥拉西坦联合醒脑静治疗脑外伤的临床效果显著，可有效缓解神经损伤，减少血清MCP-1、Caspase-3、RANTES含量，减轻局部炎症，病人病情恢复及预后良好。

Objective To comprehensively analyze the clinical effects of oxiracetam combined with Xingnaojing in the treatment of traumatic brain injury, and its effects on neuronal injury.

Methods Seventy-six patients with traumatic brain injury were randomly divided into the observation group and control group(38 cases in each group). On the basis of comprehensive treatment, the control group was treated with oxiracetam, and the observation group was treated with oxiracetam combined with Xingnaojing. The Glasgow coma score(GCS), acute physiological and chronic health status scores(APACHE Ⅱ), degree of neuron injuryserum levels of glial fibrillary acidic protein(GFAP), neuron specific enolase(NSE), calcium binding protein S100B and myelin basic protein(MBP), nerve injury repair indexeslevels of heat shock protein(HSP)-90, HSP-70, HSP-27 and nerve growth factor(NGF), inflammatory chemokinesserum monocyte chemokine 1(MCP-1), aspartate cysteine-specific proteinase-3(Caspase-3) and factors regulating the expression and secretion of activated normal T cells(RANTES) in two groups were compared between before treatment and after 14 and 28 days of treatment. The prognosis and adverse reactions between two groups were compared.

Results Compared with before treatment, the GCS scores in two groups increased, the APACHE Ⅱ scores decreased in two groups after 14 and 28 days of treatment, and which in observation group was better than that in control group( P < 0.01). The results of evaluation after 28 days of treatment showed that there was no statistical significance in the rate of good prognosis between two groups( P >0.05). After 14 and 28 days of treatment, the serum levels of GFAP, NSE, S100B, MBP, HSP-90, HSP-70, HSP-27 and NGF in two groups decreased compared with before treatment, and the decrease amplitude in observation groups was higher than that in control group( P < 0.05 to P < 0.01). The serum levels of MCP-1, Caspase-3 and RANTES in two groups after 14 and 28 days of treatment were lower than that before treatment, and which in observation group was lower than that in control group( P < 0.05 to P < 0.01). There was no statistical significance in the incidence rate of adverse reactions between two groups( P >0.05).

Conclusions Oxiracetam combined with Xingnaojing has significant clinical effect in the treatment of traumatic brain injury, which can effectively relieve the nerve injury, reduce the serum content of MCP-1, Caspase-3 and RANTES, and alleviate local inflammation. The recovery and prognosis of patients are good.