亚低温治疗对蛛网膜下腔出血继发性血管痉挛及脑脊液和血浆内皮素、降钙素基因相关肽的影响

Effects of mild hypothermia on secondary cerebral vasospasm and levels of endothelin,calcitonin gene-related peptide in CSF and plasma in patients with subarachnoid hemorrhage

目的探讨亚低温治疗对蛛网膜下腔出血(SAH)继发性血管痉挛及脑脊液和血浆内皮素(ET)、降钙素基因相关肽(CGRP)水平的影响。方法56例SAH患者随机分成亚低温组和对照组,两组在常规治疗的基础上,亚低温组增加局部亚低温治疗;检测两组入院时及治疗7d、14d脑脊液和血浆ET、CGRP水平,并比较两组脑血管痉挛的发病情况。结果(1)脑脊液、血浆ET水平治疗7d时亚低温组较对照组显著降低(均P<0.05);14d时差异更显著(均P<0.01);两组CGRP水平治疗第7d时降至最低,后渐升高,亚低温组较对照组变化幅度小,差异有统计学意义(P<0.05～0.01)。(2)亚低温组脑血管痉挛发病率为6.67%,较对照组的30.77%明显减少(P<0.05)。结论亚低温治疗减少了SAH患者脑脊液和血浆中ET水平上升幅度及CGRP水平下降幅度,从而降低脑血管痉挛的发生率。

Objective To study the effects of mild hypothermia on secondary cerebral vasospasm and levels of endothelin（ ET ）, calcitonin gene-related peptide （CGRP） in CSF and plasma in patients with subarachnoid hemorrhage （SAH）. Methods 56 patients with SAH were randomly divided into mild hypothermia group and control group. Based on the routine treating method, patients of mild hypothermia group were treated with local mild hypothermia. The levels of ET, CGRP in CSF and plasma were detected before and after treatment. And the incidence rates of secondary cerebral vasospasm cases were compared between the two groups. Results （ 1 ） At 7 d, 14 d after treatment, ET levels in CSF and plasma in mild hypothermia group were significant lower than those in control group （ P 〈 0. 05 -0. O1 ）. The CGRP levels in CSF and plasma were lowest at 7 d, then gradually increased in two groups. However, the changes of CGRP in mild hypothermia group was smaller than that in control group （P 〈 0. 05 -0. 01 ）. （2） The rate of cerebral vasospasm in mild hypothermia group was 6. 67% which significantly less than that in control group （30.77 % ） （P 〈0. 05 ）. Conclusions Mild hypothermia can prevent the increasing of ET and the decreasing of CGRP in CSF and plasma, and decrease the occurrence of vasospasm in patients with SAH.