亚低温在重症颅脑创伤患者中的应用

Effect and safety of therapeutic mild hypothermia in severe traumatic brain injury

目的探讨亚低温在重症颅脑创伤患者中应用的疗效和安全性。方法将44例重症颅脑创伤患者随机分为亚低温组（n=22）和对照组（n=22），对照组按照脑创伤常规治疗，亚低温组在此基础上给予亚低温治疗。亚低温治疗过程中动态监测颅内压、心率、血压、脉氧饱和度，每日测定血糖、血细胞分析、血气分析、凝血功能、肝肾功能、电解质，并进行GCS评分，于伤后3个月根据GOS分级评定疗效。结果亚低温维持12、24h及复温后24h，颅内压显著低于对照组；复温后24、48、72hGCS评分显著高于对照组；3个月时治愈率明显高于对照组，死亡率明显低于对照组：亚低温治疗过程中心率、血小板、血钾降低，血糖升高，与对照组比较差异有统计学意义，给予相应治疗后无不良后果。结论在重症颅脑创伤患者中，亚低温是一种安全、有效的治疗措施。

Objective To investigate the effect and safety of therapeutic mild hypothermia in severe traumatic brain injury （sTBI）. Methods 44 sTBI patients were randomly divided into therapeutic mild hypothermia group （ n = 22） and control group （ n = 22 ）. The control group was maintained at normothermic levels and received standard therapy. The therapeutic mild hypothermia group underwent mild hypothermia treatment besides the standard therapy. Intracranial pressure （ICP）, Glasgow Coma Scale （GCS）, heart rate（HR）, mean artery pressure（MAP ）, SpO2, WBC, PLT, PT, PaCO2, PaO2, K ^＋ , Na ^＋ , blood glucose and the kidney and liver functions were observed. The Glasgow Outcome Score （GOS） was tested on 90 d after the injury. Results Compared with the control group, the recovery rate was obviously higher and the mortality was lower in the mild hypothermia group on 90 d after the injury. ICP in those who underwent mild hypothermia treatment for 12, 24 h and 24 h after rewarming was significantly lower, whereas the GCS in the mild hypothermia group was higher at 24, 48 and 72 h after rewarming. The lower HR, PLT, plasma potassium and the higher blood glucose were observed in the mild hypothermia group. Conclusion Therapeutic mild hypothermia is safe and effective in the treatment of sTBI.