不同时间局部亚低温治疗弥漫性轴索损伤的预后分析

Prognosis of patients with diffuse axonal injury treated with local mild hypothermia at different times

目的 探讨弥漫性轴索损伤（DAD后不同时间点行亚低温治疗与患者预后的关系.方法 回顾性分析桂林市全州县人民医院院神经外科自2006年1月至2010年1月收治的48例弥漫性轴索损伤患者的临床资料,按照伤后有无在常规治疗的基础上加用局部亚低温辅助治疗分为亚低温治疗组（n=23）和对照组（n=25）,前者按治疗时间又分为伤后8h内亚低温治疗组（n=9）和伤后8 h后亚低温治疗组（n=14）,治疗6个月后对患者行GOS评定,分析患者的预后.结果 3组患者年龄、性别比例、治疗前颅内压、GCS评分方面差异均无统计学意义（P〉0.05）;分别接受不同治疗后3组患者预后差异有统计学意义（x2-6.671,P=0.036）,由平均秩次判断,预后最好的为伤后8 h内亚低温治疗组,其次为伤后8 h后亚低温治疗组和对照组.结论 弥漫性轴索损伤患者伤后早期（8 h内）进行局部亚低温辅助治疗有助于脑功能的恢复,提高预后.

Objective To investigate the effect of local mild hypothermia at different times on the prognosis of patients with diffuse axonal injury （DAI）. Methods Forty-eight patients with DAI,admitted to our hospital from January 2006 to January 2010, were chosen, and their general clinical data were retrospectively analyzed.According to whether adjuvant treatment with mild hypothermia was performed besides conventional therapy, patients were divided into mild hypothermia （n=23） and control group （n=25）. The former group was sub-divided into group A （giving mild hypothermia treatment within 8 h of injury, n=9） and group B （giving mild hypothermia treatment over 8 h of injury, n=14）. Patients were assessed with Glasgow outcome scale （GOS） and the prognosis of these patients was analyzed 6 months after treatment. Results No significant differences on age, gender ratio, intracranial pressure before treatment and Glasgow coma scale （GCS） scores were found among the 3 groups （P〉0.05）.Significant differences on the prognosis were found among the 3 groups （x2=6.671, P=0.036）. Determined from the average rank, the prognosis in group A was better than that in group B, and the prognosis in group B was better than that in the control group. Conclusion Local mild hypothermia therapy within 8h of injury has functional benefit in the recovery of patients with DAI and improves their prognosis.