亚低温治疗急性重型颅脑损伤的临床疗效

Clinical effect of mild hypothermia on patients with severe brain injury

目的 研究亚低温对急性重型颅脑损伤病人的治疗作用及临床效果。方法 共 87例病人 ,随机分为亚低温治疗组和对照组。亚低温治疗组 43例 ,均于伤后 2 4小时内行亚低温治疗 ,直肠温度 (RT)控制在 31 5～ 34 9℃ ,脑温为 32 0～ 35 0℃ ,持续 1～ 7天 ,平均 5 7 7± 2 8 4小时。同时监测病人的生命体征、颅内压 (ICP)、血糖、血乳酸、血气、血电解质以及脑组织氧分压 (PbrO2 )和脑组织温度 (BT)。对照组 44例 ,直肠温度控制在 36 5～ 37 5℃ ,其他治疗同亚低温组。两组病人均于伤后 3个月时根据GOS评估法判定疗效。结果 与对照组相比 ,亚低温治疗组病人伤后早期的高ICP、高血糖、高乳酸血症分别显著下降 (P <0 0 5 ) ;严重的低PbrO2 迅速上升并维持在正常水平 ;生命体征、血气及血电解质无显著差异 ;无严重并发症 ,死亡率降低 ,恢复良好率提高 ,预后显著改善。结论 亚低温具有肯定的脑保护作用 ,临床上用于治疗急性重型颅脑损伤病人 ,安全有效 ,可降低死亡率 ,提高生存质量 ,无严重并发症。直接监测PbrO2 和BT 。

Objective To study the effects of mild hypothermia on the patients with severe brain injury. Methods All 87 patients with severe brain injury (Glasgow coma scale score of 8 or less on admission) were randomly divided into the hypothermic group (43 cases) and the control group (44 cases). Hypothermia was induced within 24 hours of injury. Rewarming was begun on 1～7 days (average 57 7±28 4 hours) after the rectal temperature (RT) reached 31 5～34 9℃. Meantime, the vital signs, intracranial pressure(ICP), blood gas values, blood electrolytes, brain tissue oxygen pressure(P br O 2) and brain tissue temperature(BT) were measured. The rectal temperature of control patients was induced to 36 5～37 5℃. According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated.Results In comparison with control group, the increased ICP, hyperglycemia, raised blood lactate significantly decreased respectively in hypothermic group(P<0 05). The vital signs, blood gas values and blood electrolytes did not significantly change. The mortality decreased and good recovery cases increased, the prognosis of the patients improved. Conclusions Mild hypothermia is safe and effective for preventing brain damage of the patients with severe brain injury, which can reduce the mortality and improve the prognosis. Monitorings of P br O 2 and BT are important criteria for hypothermic therapy.