亚低温治疗对急性重型颅脑损伤患者脑脊液乳酸和血乳酸的影响分析

Mild Hypothermia in Patients with Acute Severe Head Injury Impact on Cerebrospinal Fluid Lactate and Blood Lactate

目的探讨亚低温治疗对急性重型颅脑损伤患者脑脊液乳酸和血乳酸含量变化的影响。方法 47例急性重型颅脑损伤患者随机分为亚低温治疗组24例和常温治疗对照组23例。亚低温治疗组在常规治疗基础上行亚低温治疗,直肠温度控制在32.5℃～34.5℃,持续4~5d;对照组仅行常规治疗。同时监测两组患者的脑脊液乳酸和血乳酸水平,并于伤后3个月评定预后。结果与对照组比较,亚低温治疗组患者伤后早期的脑脊液乳酸值显著下降（P〈0.01）,而血乳酸值则无明显差异（P〉0.05）,病死率下降,预后明显改善。结论亚低温治疗对重型颅脑损伤有明显疗效,可显著降低病死率,提高生存质量,脑脊液乳酸值与患者预后有很好的相关性,可作为一项评价预后的指标,而血乳酸值受全身因素影响大,不适于评价预后。

Objective To investigate the treatment of mild hypothermia in patients with acute severe brain injury impacting on cerebrospinal fluid lactate and blood lactate.Methods 47 patients with acute severe brain injury were randomly divided into hypothermia treatment group,24 cases and normal temperature treatment control group,23 cases.Hypothermia group was treated with mild hypothermia therapy on the basis of the conventional therapy,rectal temperature was controlled at 32.5℃~34.5℃,for 4 or 5 days;the control group received conventional therapy alone.At the same time monitored the 2 groups of patients＇blood lactate levels and cerebrospinal fluid lactate levels,and accessed prognosis in 3 months after injury Results Compared with the control group,the cerebrospinal fluid lactic acid in the hypothermia group was significantly decreased（P0.01）,and the blood lactate in the patients had no significant difference（P0.05）,mortality decreased significantly and prognosis improved.Conclusion Mild hypothermia on severe traumatic brain injury have significant effects,can significantly reduce mortality and improve the quality of life,cerebrospinal fluid lactate has a good correlation with the prognosis of patients and it can be used as an indicator of prognosis,and blood lactate is affected by a lot of systemic factors and it is not suitable for evaluation of prognosis.