颅脑创伤及亚低温治疗对患者脑血流的影响

The influence of traumatic brain injury and mild hypothermia therapy on patients' cerebral blood flow

目的:研究重型颅脑创伤患者外伤后早期的局部脑血流变化与预后的关系以及亚低温对其的影响。方法:对24例重型颅脑创伤患者进行了激光多普勒(LDF)脑血流(CBF)监测,平均监测开始时间为伤后14h,平均监测持续时间为56h。对其中的11例患者进行了亚低温治疗,持续24h。分析CBF变化与预后的关系及亚低温对脑血流的影响。结果:(1)在监测的0～12h阶段,低灌注组8例,其中预后良好2例,预后不良6例;非低灌注组16例,其中预后良好10例,预后不良6例。在整个监测阶段,5例患者表现为持续低灌注,预后均不良;19例患者表现为非持续低灌注,其中预后良好12例,预后不良7例。(2)11例行亚低温治疗的患者,有8例(72.7%)LDF值下降,3例(27.3%)LDF值升高。降幅自1.9%～25.2%不等,平均降幅10.45%。结论:(1)重型颅脑创伤患者在伤后早期易发生低灌注,外伤后早期低灌注与预后无关,而外伤后持续低灌注预示预后不良。(2)亚低温可以降低CBF。

Objective： To study the relationship between local cerebral blood flow（CBF）changes andprog nosis at the early stage of trauma and the effect of mild hypothermia on CBF in patients with severe head injury. Methods： CBF was measured in 24 patients with severe head injury using Laser Doppler Flowmetry （LDF）. The monitoring of CBF began at about 14 hours after trauma lasting for about 56 hours in average. 11 patients underwent treatment of mild hypothermia for 24 hours. The relationship between CBF changes and prognosis and the effect of mild hypothermia on CBF were analyzed. Results： （1） During the stage of 0-12 hours, hypoperfusion was found in 8 cases, in which 2 cases had good recover and 6 cases had poor outcome; nonhypoperfusion was found in 16 cases in which 10 cases had good recover and 6 cases had poor outcome. During the whole stage of monitoring, persistent hypoperfusion was found in 5 cases and all of them had poor outcome; non- persistent - hypoperfusion was found in 19 cases in which 12 cases had good reeover and 7 cases had poor outcome. （2） In 11 cases with mild hypothermia therapy, LDF reduced in 8 cases （72.7%） while raised up in 3 cases （27.3%）. The reducing range was from 1.9% to 25.2% with average at 10.45%. Conclusion： （1） Hypoperfusion occurs frequently at the early stage of trauma in patients with severe head injury. There is no statistically significant difference between hypoperfusion of early stage after trauma and prognosis, while persistent hypoperfusion after trauma indicates poor outcome statistieally. （2） Mild hypothermia can reduce CBF.