长期亚低温治疗对重型颅脑损伤的疗效

Clinic effect of long-term mild hypothermia on patients with severe craniocerebral injury

目的通过研究102例长期(5～10d)亚低温脑保护疗法治疗对重型颅脑损伤救治效果及预后的影响,探讨长期亚低温治疗与短期(24～72h)亚低温治疗疗效的差异。方法将102例重型颅脑损伤患者(GCS昏迷≤8分)随机分为长期亚低温治疗和短期亚低温治疗两组。长期组于伤后24h内进行亚低温治疗,共5～10d,短期组于伤后24h内开始亚低温治疗,共24～72h。直肠温度控制在32.5～34℃。同时监测病人的生命体征、颅内压(ICP)、血气、血电解质及动脉血氧饱和度。两组病人均于伤后3～6个月时根据GOS评估法判定疗效。结果长期组51例患者恢复良好率56.86%(29/51),死亡率9.8%(5/51);短期组51例患者,恢复良好率41.17%(21/51),死亡率17.64%(9/51),两组患者恢复良好率和死亡率均有明显差异(P<0.05),两组肺部感染、颅内感染、消化道溃疡、肾功能损害、心律失常发生率无明显差异,长期亚低温组死亡率降低,恢复良好率提高,预后显著改善。结论本结果提示,长期亚低温治疗较短期亚低温治疗能显著降低重型颅脑损伤患者的死亡率,改善颅脑损伤患者预后,较短期亚低温治疗未见并发症增高。

Objective To explore the different effects of mild hypothermia treatment between the long - term treatment and short -term treatment （24 -72 h） ,and to study the influence on clinic effect and prognosis by studying 102 cases with severe craniocerebral injury under hypothermia therapy. Methods One hundred and two cases of patients with severe craniocerebral injury （ GCS in a coma at ≤ 8 ） were randomly divided into long - term mild hypothermia treatment group and short - term group. Long - term group was treated with mild hypothermia within 24 hours, a total of 5 - 10 d, while short - term group started to be treated with mild hypothermia within 2,4 hours, a total of 24 - 72 h. And the rectal temperature of patients were controlled between 32.5℃ and 34℃. During the whole process,the vital signs, intracranial pressure （ICP）,blood gas, electrolytes and arterial blood oxygen saturation were monitored. According to GOS after 3 and 6 months, the efficacy of two groups was assessed. Results The good recovery rate of long - term group of 51 cases reached 56.86% （29/51） ,with the mortality rate 9.8% （5/51） ;51 cases of patients with short - term group,a good recovery rate of 41.17% （21/51） ,with the mortality rate 17.64% （9/51）. The two groups of patients with good recovery and mortality rates had significant differences （ P 〈 0.05 ）. There was no significant difference between two groups in lung infection, intracranial infections, gastrointestinal ulcers, kidney damage, the incidence of arrhythmia. The decreased mortality and good recovery were also found in long - term group. And the prognosis was significantly improved. Conclusions The present results suggest that long - term treatment of mild hypothermia can significandy reduce the death rate of patients with severe craniocerebral than short - term treatment and can improve the prognosis. There are no increased complications.