亚低温对重型颅脑损伤患者T细胞亚群及预后的影响

The effect of mild hypothermia on T lymphocyte subsets and prognosis of patients with severe brain injury

目的研究亚低温对急性重型颅脑损伤患者T细胞亚群及预后的影响。方法重型颅脑损伤患者共40例,随机分为亚低温组和对照组,亚低温组20例,于伤后24 h内行亚低温治疗,直肠温度控制在32~34℃,持续1~7 d;并监测患者的生命体征、颅内压（ICP）、血糖、血气、血电解质等治疗;对照组20例,除未应用亚低温治疗外其余治疗相同;亚低温组和对照组分别于伤后第1、3、7 d取外周静脉血采用流式细胞术检测T淋巴细胞亚群CD3、CD4、CD8阳性细胞及CD4/CD8阳性细胞比值,两组间进行比较。伤后3个月时根据GOS评估法判定疗效。结果亚低温组和对照组之间比较,伤后第1、3、7 d T细胞亚群无统计学差异;预后比较,有统计学差异。结论亚低温治疗重型颅脑损伤可以提高患者的预后,不会加重T细胞免疫功能损伤,临床应用安全有效,有良好的临床应用前景。

Objective To study the effect of mild hypothermia on T lymphocyte subsets and prognosis of patients with severe brain injury. Methods All 40 patients with severe brain injury were randomly divided into the mild hypothermic group（20 cases） and the control group（20 cases）,Hypothermia was induced within 24 hours of injury,Rewarming was begun on 1～7 days after the rectal temperature（RT）reached 32℃～34℃.Meantime,the vital signs,intracranial pressure（ICP）,blood glucose,blood gas values and blood electrolytes were measured.The rectal temperature of control patients was induced to 36.3～37.5℃.the two group were detected with T lymphocyte subsets of venous blood on days 1、3、7 post injury by flow cytometry.According to Glasgow Outcome Scale（GOS）,the prognosis of the patients was evaluated.Results In comparison with control group,lymphocyte subsets didn＇t have difference on days 1、3、7 post injury;There was difference between the two groups in the increased ICP;The mortality decreased,good recovery cases increased and the prognosis of the patients improved.Conclusions Mild hypothermia is safe and effective for preventing brain damage of the patients with severe brain injury.And it can reduce the mortality and improve the prognosis.