轻度低温联合依达拉奉治疗提高重型颅脑损伤疗效

Mild hypothermia therapy plus edaravone improves neurological outcomes in patients with severe traumatic brain injury

目的 探讨轻度低温联合依达拉奉治疗急性重型颅脑损伤的疗效. 方法 选取自2008年2月至2012年9月在深圳市龙岗中心医院急诊入院的重型颅脑损伤患者共143例,按随机数字表法分为4组：对照组（A组,n=35）,给予常规治疗；轻度低温治疗组（B组,n=36）,给予常规治疗加轻度低温（33～34℃）治疗,持续时间2～14d;依达拉奉治疗组（C组,n=36）,给予常规治疗加依达拉奉30 mg/次,2次/d,连用14d;轻度低温联合依达拉奉治疗组（D组,n=36）,给予常规治疗加轻度低温和依达拉奉联合治疗.记录4组患者入院时、入院后24 h、72 h颅内压（ICP）及检测血糖值.治疗后3个月应用格拉斯哥预后评分（GOS）评价疗效. 结果 入院后24 h、72 h时B组、C组平均ICP、血糖值均明显低于A组,D组均明显低于B组、C组,差异均有统计学意义（P＜0.05）.D组疗效良好（GOS评分4～5分）率明显优于B组、C组及A组,差异均有统计学意义（P＜0.05）. 结论 早期应用轻度低温与依达拉奉联合治疗急性重型颅脑损伤患者的疗效显著优于单纯应用轻度低温或依达拉奉治疗.

Objective To observe the treatment effect of edaravone plus mild hypothermia treatment on patients with acute severe traumatic brain injury （TBI）.Methods One hundred and forty-three patients with TBI,admitted to our hospital from February 2008 to September 2012,were randomly divided into 4 groups：control group （group A,routine treatment,n=35）,mild hypothermia treatment group （group B,routine treatment plus temperature control at the range of33～34 ℃ for 2-14 days,n=36）,edaravone treatment group （group C,routine treatment plus edaravone up to 14 days,30 mg per time,twice per day,n=36） and mild hypothermia plus edaravone treatment group （group D,routine treatment combined with mild hypothermia plus edaravone n=36）.Intracranial pressure （ICP） and arterial blood glucose were determined at admission,and 24 and 72 h after admission; Glasgow Outcome Scale （GOS） scores were assessed 3 months after the treatment.Results At 24 and 72 h after admission,the mean ICP of group B and group C was significantly lower than that of group A （P〈0.05）; that of group D was significantly lower than that of group B and group C （P〈0.05）.The mean blood glucose of group B and group C was obviously lower than that of group A （P〈0.05）; group D was obviously lower than group B and group C （P〈0.05）.The rate of good neurologic function （GOS scores 4-5） in group D was better than that of group B and group C （P〈0.05）,which was significantly better than that of group A （P〈0.05）.Conclusion It is much more effective to use mild hypothermia plus edaravone treatment than simple mild hypothermia or edaravone treatment in the early treatment of acute severe TBI.