贴敷式局部亚低温治疗对急性重症脑出血疗效及免疫功能的影响观察

Local subhypothermia in treatment of acute severe cerebral hemorrhage and its effect on immunological function

目的观察贴敷式局部亚低温脑保护仪治疗对急性重症脑出血的疗效及患者免疫功能的影响。方法将60例诊断为急性重症脑出血患者随机分为亚低温组和对照组,两组均给予常规治疗,亚低温组同时给予贴敷式局部亚低温脑保护治疗。观察两组患者脑出血水肿体积,美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数(BI)的变化判断两组患者的致残情况,检测两组患者体内CD4^+和CD8^+T细胞数的变化;统计两组患者的病死率、感染发生率。结果(1)治疗14d,亚低温组患者脑水肿体积较对照组有好转趋势(P<0.05);(2)两组治疗初期NIHSS评分及BI无差异(P>0.05),而治疗30、180d亚低温组评分与对照组相比,NIHSS及BI有差异(P<0.05);(3)重症脑出血患者存在细胞免疫功能的紊乱,主要表现为CD4^+降低,卒中相关性感染与低水平CD4^+基本吻合,治疗组感染发生率有降低趋势,但差异无统计学意义(P>0.05),CD8^+T细胞在整个病程中差异无统计学意义。结论贴敷式局部亚低温脑保护仪治疗安全有效,且对急性重症脑出血细胞免疫功能紊乱有调节作用。

Objective To evaluate the efficacy of local subhypothermia with adhesive dressing for severe brain hemor-rhage and its effect on immunological function of patients. Methods Sixty patients with acute severe cerebral hemorrhage were randomized into 2 groups： subhypothermia group （n=30） and control group （n=30）. Al patients were given conventional therapy;while patients in subhypothermia group received additional subhypothermia therapy with local adhesive dressing. The volume of the cerebral edema or infarction, NIH Stroke Scale and the activity of daily living score （Barthel Index）were evaluated to judge disable level between zgroups. The CD4＋, CD8＋ cel s in peripheral blood were measured. The fatality rate and infection rate were observed and compared between two groups. Results The volume of edema or cerebral infarct was lower in subhypothermia group than that in control groups after 14d treatment （P〈0.05）. There was no significant difference in baseline NIHSS and BI scores between two groups （P 〉0.05）, the scores were improved more markedly in subhypothermia group than those in control group after 30 and 180d treatment （P〈0.05）. Conclusion The local subhypothermia therapy is safe and effective for patients with acute cerebral hemorrhage.