不同启始时间头部低温对大面积脑梗死并中枢性高热降温效果比较

Comparison of therapeutic efficacy of hypothermia treatment with different starting time on centric high fever after large-acreage cerebral infarction

目的观察不同启始时间头部低温对大面积脑梗死(LCI)合并中枢性高热的降温效果。方法将154例中枢性高热LCI病人按入院时间顺序分为4组,A组34例,为高热后≤3 h行头部低温降温;B组35例,为高热后4-6 h行头部低温降温;C组45例,为7-9 h行头部低温降温;D组40例,为10-12 h行头部低温降温。结果 4组比较,头部低温治疗时间无显著性差异(均P>0．05),3 d体温恢复率无显著性差异(均P>0．05),体温再发率以A、B两组最低(均P<0．05),生存者治疗前后神经功能缺损程度评分(NDS)、日常生活能力评定(ADL)以A、B两组效果最佳(均P<0．05),肺部感染以 C、D发生率为高(均P<0．05)。结论 LCI中枢高热者6 h内应用头部低温治疗可达到治疗及降温双重作用。

Objective To observe the efficacy of hypothermia treatment on centric high fever （CHF） after large-acreage cerebral infarction （LCI）. Method All 154 cases of CHF were divided into 4 groups. Hypothermia treatment was performed 3 hours, 4 to 6 hours, 7 to 9 hours, and 10 to 12 hours after cerebral infarction in group A （n=34）, group B （n=35）, group C （n=45） and group D （n=45） respectively. Results Among the four groups, there were no significant differences in the treatment time of head hypothermia （P 〉 0.05） and the rate of body temperature （P 〉 0.05）. Group A and B had lowest recurrence of hyperthrmia, highest treatment effect according to comparison of neurological deficit scores （NDS） and activity daily living （ADL） （P 〈 0.05 ）. Group C and D had highest recurrence of lung infection （P 〈 0.05）. Conclusion There was dual effect for treating and decreasing temperature if head hypothermia treatment got started 6 hours after LCI on centric high fever.