急性脑梗死局部亚低温治疗的时间窗研究

Therapeutic window for local mild hypothermia in patients with acute cerebral infarction

目的 探讨局部亚低温治疗急性脑梗死的疗效和最佳治疗时间窗. 方法 将114例急性脑梗死患者按开始接受亚低温治疗时间的不同分为3组,即A组（≤6 h）、B组（6～24 h）和C组（≥24 h）,每组再按随机数字表法分为治疗组（A1组、B1组、C1组）和对照组（A2组、B2组、C2组）.对照组给予常规抗血小板等治疗,治疗组在常规治疗基础上给予病灶侧局部亚低温治疗48 h.各组患者均在人院时、治疗第7天、治疗第14天、治疗第30天进行美国国立卫生研究院卒中量表（NIHSS）评分,并在入院时及治疗第7天、治疗第14天动态监测血清中一氧化氮（NO）含量、超氧化物歧化酶（SOD）活力. 结果 与A2组、B2组相比,A1组、B1组治疗第7天、治疗第14天、治疗第30天NIHSS评分明显降低,治疗第7天、治疗第14天血清中NO含量明显降低,SOD活力明显升高,差异均有统计学意义（P＜0.05）;而C1组在各时间点的NIHSS评分、NO含量、SOD活力与C2组比较差异均无统计学意义（P＞0.05）.A1组、B1组在治疗第7天、治疗第14天、治疗第30天NIHSS评分较C1组明显下降,在治疗第7天、治疗第14天NO含量较C1组明显下降,SOD活力较C1组明显提高,差异均有统计学意义（P＜0.05）,尤以A1组突出. 结论 早期局部亚低温治疗急性脑梗死临床有效,理想的治疗时间窗为6 h,6～24 h开始亚低温治疗仍有效,但24 h后开始亚低温治疗则无效.

Objective To determine the effect of local mild hypothermia on patients with acute cerebral infarction and ascertain its optimal therapeutic window. Methods According to the time receiving treatment, 114 patients with acute cerebral infarction were divided into group A （≤6 h）, group B （6-24 h） and group C （≥ 24 h）. Then, each group was subdivided into 2 groups at random： treatment group （A1, B1, C1） and control group （A2, B2, C2）. Patients in the control group were subjected to such conventional therapy as anti-platelet aggregation. Patients in the treatment group were treated with local mild hypothermia （33-35 ℃ body-core temperature） for 48 h besides conventional therapy. Clinical outcomes were assessed by the National institutes of health stroke scale （NIHSS） on admission and 7, 14,30 d after treatment. Furthermore, we detected the serum level of nitrogen monoxidum （NO） and superoxide dismutasc （SOD） on admission, and 7 and 14 d after treatment. Results Compared with the control group, treatment group enjoyed significantly decreased scores of NIHSS 7, 14 and 30 d after treatment and significantly decreased level of NO 7 and 14 d after treatment （P〈0.05）, but obviously increased SOD vitality 7 and 14 d after treatment （P〈0.05）. No significant differences in terms of NIHSS scores, level of NO and SOD vitality were noted between group C1 and group C2 at each time point （P〉0.05）. Group Al and group B1 had obviously lower scores of NIHSS than group C1 on the 7th, 14th and 30th d of treatment, and had significantly lower level of NO and obviously increased SOD vitality as compared with group C1 on the 7th and 14th d of treatment （P〈 0.05）, and group A1 enjoyed its advantage.Conclusion Early local mild hypothermia therapy can improve neurological function in patients with acute cerebral infarction. The mild hypothermia induced within 6 h may be optimal therapeutic window;mild hypothermia induced at 6-24 h is less effective and that above 24 h is non-effective.