亚低温状态下大剂量硫酸镁治疗弥漫性轴索损伤的临床研究(英文)

The effects of combined mild hypothermia and high dose of magnesium sulfate in the treatment of diffuse axonal injury

目的 观察联合使用亚低温及大剂量硫酸镁治疗弥漫性轴索损伤的临床效果。方法 6 4例诊断为弥漫性轴索损伤 ,GCS评分为 3～ 8的患者被随机分为治疗组和对照组。治疗组的患者入院 2 0min后给予静注 2 4mmol硫酸镁 ,再用 80mmol持续 2 4h静滴 ,同时自伤后 6h开始联合用亚低温治疗 ,使直肠温度控制在 33～ 35℃ ,治疗时间为 3～ 5d ,对照组按普通常规治疗。两组患者均于入院当天、治疗后 3d和 7d测血清神经元特异性异烯醇化酶(NSE)和GCS ,出院和 3个月后测GOS。结果 治疗组和对照组的血清NSE ,GCS和GOS分别为 (2 4 . 8± 19. 2 )g L ,12 . 3± 3. 3,4 . 6± 1. 3和 (4 9. 7± 2 3. 1)g L ,9.8± 2 . 8,3. 0± 1. 5 ,两组差异有显著性 (P <0 . 0 1)。

Objective To observe the clinical effects of combined mild hypothermia and high dose of magnesium sulfate (MHMS) in treatment of diffuse axonal injury (DAI). Methods 64 patients suffered from DAI and had Glasgow Coma Scale (GCS) scores of 3 to 8.They were randomly divided into two groups: MHMS treatment group (n=32) and control group (n=32).MHMS treatment group: mild hypothermia was used to keep the rectal temperature at 33 to 35℃ and received 24 mmol magnesium sulfate intravenously at 20 minutes after admission,followed by 80 mmol magnesium sulfate intravenously everyday for 3 to 5 days.Control group: patients were only treated with common method without MHMS.Serum neuron specific enolase (NSE),GCS and GOS of all the patients were measured.GCS score was recorded at admission,at 3 days,7 days,and 2 weeks;serum NSE values was measured at admission,at 3 days and 7 days.Outcome was determined by Glasgow Outcome Scale (GOS) score at discharge and after 3 months.The data were analyzed statistically. Results The serum NSE,GCS and GOS in the MHMS group were (24.8±19.2)g/L,12.3±3.3 and 4.6±1.3,respectively;while in control group were (49.7±23.1) g/L,9.8±2.8 and 3.0±1.5,respectively.There was significant difference between the two groups in serum NSE,GCS and GOS (P<0.01). Conclusion Mild hypothermia combined with high dose of magnesium sulfate therapy is effective in the treatment of patients with DAI.