亚低温在重型颅脑损伤中的应用研究

楼　屹　冯杨荣

亚低温在重型颅脑损伤中的应用研究

楼屹冯杨荣

目的 探讨亚低温治疗重型颅脑损伤的疗效和安全性。方法 将66例重型颅脑损伤患者按治疗方法不同分为亚低温组（n=31）和对照组（n=35），对照组是常规治疗组，亚低温组在常规治疗基础上采用轻度低温，长时间维持，缓慢复温治疗。观察两组患者住院病死率，机械通气时间，住ICU天数及各种感染、寒战等并发症发生情况。动态监测两组患者心率、血压、血常规、C反应蛋白、凝血功能、电解质、血糖、颅内压（ICP）变化，并对存活患者于伤后6个月进行格拉斯哥昏迷评分（GCS），格拉斯哥预后评分（GOS）分级评定疗效。结果 在临床情况、疾病严重程度基本相似的两组患者中，亚低温组机械通气时间、住ICU天数、住院病死率低于对照组（P＜0.05），而各种感染、寒战发生率类似（P＞0.05），治疗3d后亚低温组心率、血白细胞、C反应蛋白、血糖水平较对照组明显下降（P＜0.05），平均动脉压、血小板、血钾较对照组稍有下降，凝血酶原时间较对照组稍有延长，但并不显著（P＞0.05），亚低温组术后治疗72h、120h后ICP水平较对照组明显下降（P＜0.05），亚低温组存活患者6个月时GCS评分、GOS分级治愈率较对照组明显升高（P＜0.05）。结论 轻度低温、长时间维持、缓慢复温的亚低温治疗方法对重型颅脑损伤患者可能具有较好的临床疗效，且患者耐受性良好。

亚低温 重型颅脑损伤 疗效

Objective To investigate the efficacy and safety of mild hypothermia in treatment of severe traumatic brain injury. Methods According to the difference of treatment，66 patients with severe traumatic brain injury were divided into mild hypothermia group （n=31）and control group （n=35）. The control group was treated with conventional therapy，the mild hypothermia group was treated with mild hypothermia for a long tim，then slow rewarming treatment on the basis of conventional therapy. The following aspects of the two groups were observed after treatment ： hospital mortality，duration of mechanical ventilation，ICU stay and infections，chills and other complications. Dynamic monitoring of the two groups of patients with heart rate，blood pressure，blood count，C reactive protein，coagulation，electrolytes，glucose，intracranial pressure changes，After 6 months later，testing GCS score for injury patients，using GOS grading to evaluate the curative effect. Results Among the two groups，patients in the clinical situation，with the similar severity of the disease，in the hypothermia group，mechanical ventilation time，ICU stay days，the fatality rate was lower than the control group （P＜0.05），and a variety of infections，the incidence rate was similar （P＞0.05），after 3 days of treatment with mild hypothermia group，heart rate，white blood cell，C C-reactive protein，blood glucose level decreased significantly compared with the control group （P＜0.05），mean arterial pressure，blood platelet，blood potassium group slightly decreased compared with the control group，the prothrombin time was slightly longer than that of the control，but not significant （P＞0.05），after 72 hours and 120 hours operation treated with mild hypothermia group，the intracranial pressure level decreased significantly compared with the control group （P＜0.05），GCS score for hypothermia group survival of patients at 6 months，GOS grade cure rate was significantly higher than the control group （P＜0.05）. Conclusion Mild hypothermia，long time maintenance，slow rewarming treatment for severe craniocerebral injury patients may have good clinical efficacy，and the patient is well tolerated.

Hypothermia Severe Brain Injury Efficacy

亚低温在重型颅脑损伤患者中应用已多年，虽然显示出了一定的脑保护作用，显著降低病死率，但仍存有争议［1～3］。因为亚低温治疗全身体温管理复杂，使其全身性并发症风险增加。……