血管内热交换降温对患者重型外伤性脑损伤的影响

Effect of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients

目的探讨血管内热交换降温对患者重型外伤性脑损伤的影响。方法选择格拉斯哥昏迷评分（GCS评分）3—8分的重型外伤性脑损伤患者20例，采用随机数字表法，将患者随机分为冰袋降温组（IBC组）和血管内热交换降温组（EVC组），每组10例。IBC组术后采用冰袋降温，EVC组于手术开始时采用血管内热交换技术进行34℃亚低温治疗，维持至术后48h。于术前10min（基础状态）和术后24、48、72、96h时取外周静脉血样，采用酶联免疫法测定血清神经元特异性烯醇化酶（NSE）、髓鞘碱性蛋白（MBP）和S-100B的浓度。分别于术前10rain和术后8、12、24、48、72h时记录HR、MAP、颅内压（ICP）和脑灌注压（CPP），于术前10min和术后12、24、48、72h时行GCS评分，术后6个月行格拉斯哥预后评分（GOS评分）。结果与IBC组比较，EVC组术后8h和12h时HR降低，术后72h时MAP升高，术后12、24、48和72h时ICP降低，CPP升高，术后24、48、72和96h时NSE的浓度及术后48、72、96h时MBP和S-100B浓度降低，术后6个月GOS评分升高（P〈0．05或0．01）；与基础状态比较，IBC组术后12h时GCS评分降低，术后8、12、24、48、72h时HR升高，术后24、48、72、96h时NSE和S-100B的浓度及术后48、72、96h时MBP浓度升高，EVC组术后48、72h时HR升高，术后72h时MBP及术后48h时S-100B浓度升高（P〈0．05或0．01）。结论通过血管内热交换降温技术进行34℃亚低温可有效减轻患者重型外伤性脑损伤的程度。

Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups （ n = 10 each） ： ice bay cooling group （group IBC） and endovascular cooling group （group EVC）. The state of consciousness was scored on a Glasgow coma scale （GCS）. The patients had GCS scores of 3-8. The patients underwent emergency surgery. A probe of intracranial pressure monitor was placed during operation. In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system （CoolGard 3000, Alsius, USA）. In group EVC body temperature was reduced to 34 ℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure （ICP） were continuously monitored and cerebral perfusion pressure （CPP） was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase （NSE）, myelin basic protein （MBP） and S-100B （by enzyme linked immunosorbent assay） and GCS scores were assessed at 10 min before （baseline） and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale（GOS）. Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.